Skip Navigation



BJA Advance Access published online on February 7, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael019
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
96/4/455    most recent
ael019v1
Right arrow E-Letters: Submit a response to the article
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by von Roten, I.
Right arrow Articles by Spahn, D. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by von Roten, I.
Right arrow Articles by Spahn, D. R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted December 16, 2005

Laboratory Investigation

Molar substitution and C2/C6 ratio of hydroxyethyl starch: influence on blood coagulation{dagger}

I. von Roten 1, C. Madjdpour 1, P. Frascarolo 1, M.-A. Burmeister 2, A. Fisch 3, S. Schramm 1, T. Bombeli 4, and D. R. Spahn 1 *

1 Department of Anaesthesiology, University Hospital Lausanne, Lausanne, Switzerland
2 Department of Anaesthesiology, B. Braun Melsungen AG, Melsungen, Germany
3 Pharmaceutical Development, B. Braun Medical SA, Crissier, Switzerland
4 Coagulation Laboratory, Division of Haematology, University Hospital of Zürich, Zurich, Switzerland

* To whom correspondence should be addressed.
D. R. Spahn, E-mail: donat.spahn{at}chuv.ch


  Abstract

Background. Development of hydroxyethyl starches (HES) with a low impact on blood coagulation but a long intravascular persistence is of clinical interest. A previous in vitro study showed that low substituted high molecular weight HES does not compromise blood coagulation more than medium molecular weight HES. In the present study we assessed the individual effects on blood coagulation of molar substitution and C2/C6 ratio of a high molecular weight HES.

Methods. Blood was obtained from 30 healthy patients undergoing elective surgery and mixed with six high molecular weight (700 kDa) HES solutions differing in their molar substitution (0.42 and 0.51) and C2/C6 ratio (2.7, 7 and 14) to achieve 20, 40 and 60% dilution. Blood coagulation was assessed by Thrombelastograph® analysis (TEG) and plasma coagulation tests. Data were compared using a three-way analysis of variance model with repeated measures on the three factors.

Results. Higher molar substitution compromised blood coagulation most (for all TEG parameters, P<0.05). The lowest C2/C6 ratio was associated with the lowest effect on blood coagulation; r (P<0.001), angle {alpha} (P=0.003) and coagulation index (P<0.001). No effect on k and maximum amplitude was observed (P for both >0.50). The higher molar substitution was associated with a lesser increase in PT (P=0.007) and a greater decrease in factor VIII (P=0.010). PTT, functional and antigenic von Willebrand factors were not significantly influenced by molar substitution (P for all >0.20). No significant differences between solutions with the same molar substitution but different C2/C6 ratios were found in plasma coagulation parameters (P for all >0.05).

Conclusions. TEG analysis indicates that high molecular HES with a molar substitution of 0.42 and a C2/C6 ratio of 2.7 has the lowest effect on in vitro human blood coagulation.

Keywords: blood, coagulation; colloid; starch, hydroxyethyl.
{dagger}Declaration of interest. This study was funded by a grants from B. Braun Melsungen AG and the Department of Anaesthesiology of the University Hospital Lausanne. Marc-Alexander Burmeister and Andreas Fisch are employees of B. Braun AG (Melsungen and Crissier) and Donat R. Spahn is doing paid consulting for B. Braun Medical AG, Switzerland. The Department of Anaesthesiology of the University Hospital Lausanne has done other research projects in collaboration with B. Braun Melsungen AG and has thereby received other funding in the past. The Department of Anesthesiology of the University Hospital Lausanne has also received educational funds from competitor companies.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Br J AnaesthHome page
J. Boldt, S. Suttner, C. Brosch, A. Lehmann, and A. Mengistu
Influence on coagulation of a potato-derived hydroxethylstarch (HES 130/0.42) and a maize-derived hydroxethylstarch (HES 130/0.4) in patients undergoing cardiac surgery
Br. J. Anaesth., February 1, 2009; 102(2): 191 - 197.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
D. Viuff, B. Lauritzen, A. E. Pusateri, S. Andersen, R. Rojkjaer, and P. I. Johansson
Effect of haemodilution, acidosis, and hypothermia on the activity of recombinant factor VIIa (NovoSeven(R))
Br. J. Anaesth., September 1, 2008; 101(3): 324 - 331.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
T. Hitosugi, T. Saito, S. Suzuki, I. Kubota, E. Shoda, T. Shimizu, and Y. Oi
Hydroxyethyl Starch: The Effect of Molecular Weight and Degree of Substitution on Intravascular Retention In Vivo
Anesth. Analg., September 1, 2007; 105(3): 724 - 728.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. Boldt, M. Wolf, and A. Mengistu
A New Plasma-Adapted Hydroxyethylstarch Preparation: In Vitro Coagulation Studies Using Thrombelastography and Whole Blood Aggregometry
Anesth. Analg., February 1, 2007; 104(2): 425 - 430.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.