A New Plasma-Adapted Hydroxyethyl Starch Preparation: In Vitro Coagulation Studies
published online 11 December 2009.
Objective
Preparing hydroxyethyl starch (HES) in a plasma-adapted solution is supposed to improve safety with regard to coagulation. The influence of a new plasma-adapted HES preparation on coagulation was studied.
Design
Operator-blinded, randomized study.
Setting
Laboratory in vitro study.
Participants
Fifteen healthy young men scheduled for blood donation.
Interventions
Blood was diluted by 10%, 30%, and 50% using either a plasma-adapted or nonplasma-adapted (prepared in saline solution) potato-derived 6% HES 130/0.42. Only the composition of the solvent of the 2 HES preparations was different.
Measurements and Main Results
Rotation thromboelastometry (ROTEM; Pentapharm, Munich, Germany) was used to assess changes in coagulation; whole blood aggregometry with 3 inducers was used to assess effects of dilution with HES on platelet function. Clotting time (CT) and clot formation time were significantly prolonged by 30% and 50% dilution, showing significantly longer times in the non–plasma-adapted than in the plasma-adapted HES group (eg, intrinsic CT at the 30% dilution level: plasma-adapted HES 228 ± 26 seconds [within normal range] v 269 ± 29 seconds in the nonplasma-adapted HES group). Clot strengthening and clot firmness were significantly reduced by the non–plasma-adapted HES at the 30% dilution level. Platelet aggregation was significantly more reduced by the non–plasma-adapted HES at the 30% and 50% dilution levels.
Conclusions
Dilution with the nonplasma-adapted HES 130/0.42 was associated with more negative effects on thromboelastometry and platelet aggregation than the same HES 130/0.4 dissolved in a plasma-adapted solution. The benefits of using a plasma-adapted modern HES preparation on blood loss and use of blood/blood products in cardiac surgery need to be studied.
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
Address reprint requests to Joachim Boldt, MD, Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr 79, D-67063 Ludwigshafen, Germany
ABSTRACT