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Artificial colloids impair haemostasis. An in vitro study using thromboelastometry coagulation analysis.

T T Niemi1, A H Kuitunen

  • 1Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. tomi.niemi@hus.fi

Acta Anaesthesiologica Scandinavica
|March 9, 2005
PubMed
Summary

Hydroxyethyl starch (HES) solutions, regardless of substitution degree, impair blood coagulation. Gelatin and albumin caused fewer coagulation abnormalities than HES in vitro, with albumin being the least disruptive.

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Area of Science:

  • Anesthesiology
  • Hematology
  • Pharmacology

Background:

  • Hydroxyethyl starch (HES) solutions are known to impair haemostatic mechanisms.
  • The specific impact of the degree of substitution (DS) in HES solutions on thromboelastometry tracings remains unclear.
  • This study investigates the effect of DS on HES-induced haemostatic defects.

Purpose of the Study:

  • To assess the influence of HES degree of substitution (DS) on whole blood coagulation.
  • To compare the effects of different colloids (HES, gelatin, albumin) on coagulation parameters.
  • To analyze haemodilution effects using thromboelastometry.

Main Methods:

  • Whole blood from 12 volunteers was analyzed using rotational thromboelastometry (ROTEM).
  • In vitro haemodilution was performed using 6% low-molecular weight HES (high/low DS), 4% succinylated gelatin (GEL), and 4% albumin (ALB).

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  • Colloid end-concentrations of 20%, 40%, and 60% were tested.

    • Main Results:

    • Both high (0.7) and low (0.4) DS HES solutions comparably reduced maximum clot firmness (MCF) and shear elastic modulus (G) at 20% and 40% dilutions.
    • At 60% dilution, high DS HES showed less reduction in alpha-angle and MCF compared to low DS HES.
    • All colloids shortened coagulation time; HES caused greater reductions in MCF and G than albumin and gelatin at all dilutions. Gelatin further impaired coagulation more than albumin at higher dilutions.

    Conclusions:

    • The degree of substitution of HES solutions had a modest impact on thromboelastometry coagulation analysis in vitro.
    • Haemodilution with gelatin and albumin induced fewer coagulation abnormalities compared to HES.
    • Albumin solutions demonstrated the least impairment of coagulation among the tested colloids.