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Hydroxyethyl starches in equine medicine.

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Hydroxyethyl starches (HES) show weak evidence for equine use, with limited species-specific data. While beneficial for specific conditions like hemorrhagic shock, HES should be used judiciously in horses due to potential adverse effects.

Keywords:
HEScolloidfluid therapyhorsehypoalbuminemiaresuscitation

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Area of Science:

  • Veterinary Medicine
  • Pharmacology
  • Critical Care

Background:

  • Hydroxyethyl starches (HES) are colloids used for fluid resuscitation.
  • Human medicine guidelines now limit HES use due to adverse effects and questionable benefits.
  • Equine use of HES is largely extrapolated from human data with limited species-specific research.

Purpose of the Study:

  • To review and discuss the application of hydroxyethyl starches (HES) in equine veterinary medicine.
  • To provide evidence-based recommendations for HES use in horses.
  • To evaluate the efficacy and safety of HES in equine patients.

Main Methods:

  • Comprehensive review of veterinary and human peer-reviewed medical literature.
  • Inclusion of scientific reviews, meta-analyses, and original research articles.
  • Analysis of data regarding HES effects on volume expansion, colloid osmotic pressure, coagulation, and adverse events in horses.

Main Results:

  • Limited evidence supports HES superiority over crystalloids for volume expansion in horses.
  • HES can increase colloid osmotic pressure, but its impact on clinical outcomes is unproven.
  • Dose-dependent coagulopathic changes occur with HES, but clinical coagulopathies are not evidenced; data on acute kidney injury and mortality are insufficient.
  • HES use should be restricted in septic horses but may be considered for hemorrhagic shock, hypoalbuminemia, or perioperative fluid replacement.

Conclusions:

  • The evidence supporting HES use in horses is weak due to a lack of equine-specific studies.
  • Species differences necessitate cautious application of HES, acknowledging potential benefits in select cases.
  • Further research is crucial to enhance understanding and establish definitive recommendations for HES in equine veterinary medicine.