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In vitro effects of different medium molecular hydroxyethyl starch solutions and lactated Ringer's solution on
C J Konrad1, T J Markl, G K Schuepfer
1Department of Anesthesiology and Intensive Care, Ruprecht Karls-University of Heidelberg, Faculty of Clinical Medicine Mannheim, Germany. fieber-konrad@t-online.de
Anesthesia and Analgesia
|January 29, 2000
Summary
Hydroxyethyl starch (HES) solutions impact blood coagulation differently. In vitro studies suggest HES 130,000 may offer advantages in clot formation and retraction compared to other HES preparations.
Area of Science:
- Anesthesiology
- Hematology
- Pharmacology
Background:
- Hydroxyethyl starch (HES) solutions are volume expanders used in clinical practice.
- Different HES preparations vary in molecular weight, degree of hydroxylation, and substitution ratios, potentially affecting hemostasis.
- Understanding these variations is crucial for safe clinical use.
Purpose of the Study:
- To compare the in vitro effects of three different HES solutions (70,000, 130,000, and 200,000 Da) on coagulation parameters.
- To evaluate the influence of hemodilution on hemostasis in the presence of HES solutions and lactated Ringer's solution.
- To identify potential differences in clot formation and retraction among the tested solutions.
Main Methods:
- In vitro study involving hemodilution of whole blood with three HES preparations and lactated Ringer's solution.
- Analysis of coagulation using routine laboratory variables and the SONOCLOT analyzer (viscoelastic testing).
- Assessment of both cellular and plasmatic hemostatic systems.
Main Results:
- All tested HES solutions, unlike lactated Ringer's solution, interfered with the early stages of coagulation (clot rate).
- HES 70,000 significantly affected clot maturation and speed.
- HES 130,000 demonstrated improved clot formation and retraction compared to other HES solutions at 33% dilution.
Conclusions:
- HES 130,000 appears to be preferable among the tested medium molecular weight HES solutions regarding specific aspects of clot formation and retraction.
- Lactated Ringer's solution minimally affected clot formation, with a minor impact on early clotting activation.
- The choice of HES preparation may influence hemostatic function during hemodilution.
