Does Hextend impair coagulation compared to 6% hetastarch? An ex vivo thromboelastography study

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Hematology

Background:

• Fluid resuscitation is critical in managing shock.
• Plasma expanders like hetastarch are commonly used.
• The impact of different solutions on coagulation requires investigation.

Purpose of the Study:

• To compare the effects of 6% hetastarch in normal saline (HSNS) versus 6% hetastarch in lactated Ringer's solution (HSLR) on blood coagulation.
• To analyze coagulation changes during simulated hemodilution using thromboelastography (TEG).

Main Methods:

• Ex vivo thromboelastography (TEG) model using healthy human whole blood (WB).
• Simulated hemodilution with normal saline (NS), HSNS, and HSLR at varying concentrations.
• Assessed coagulation parameters over a 6-hour period.

Main Results:

• Both HSNS and HSLR significantly impaired coagulation compared to WB controls and NS.
• Progressive dilution with NS also impaired coagulation, but less severely than hetastarch solutions.
• Hetastarch at manufacturer-recommended doses significantly reduced clot strength, increasing bleeding risk.

Conclusions:

• Citrated whole blood from healthy donors provides reproducible TEG data for at least 6 hours.
• Both hetastarch solutions compromise hemostasis at clinically relevant concentrations.
• Replacing NS with LR in 6% hetastarch does not improve hemostatic properties in this in vitro model.