Influence of hydroxyethyl starch on coagulation in patients during the perioperative period.
The perioperative use of hydroxyethyl starch (HES) has been implicated as a possible cause of intracranial bleeding. The purpose of this study was to compare the influence on blood coagulation of the isovolemic replacement of 1-L blood loss with either 6% HES (molecular weight [MW] average: 450,000) or 5% human albumin during neurosurgery or lower abdominal surgery. Twenty patients scheduled for brain tumor surgery and 20 patients undergoing transabdominal hysterectomy were studied. The activated partial thromboplastin time, prothrombin time, fibrinogen concentration, factor VIII coagulant, von Willebrand factor antigen, platelet count, and the activated clotting time were compared after induction of anesthesia, after administration of 500 and 1000 mL of colloid solution, and 24 and 48 h postoperatively. All measured coagulation variables remained within physiologic range. Changes in coagulation indices were identical in neurosurgical and hysterectomy patients, except for a larger increase in fibrinogen concentration 24 and 48 h after hysterectomy. The acute phase reaction of factor VIII coagulant and von Willebrand factor, which plays a role in postoperative hypercoagulability, was attenuated by the use of HES. We conclude that isovolemic replacement of 1-L blood loss with either 6% HES (MW average: 450,000) or 5% human albumin does not interfere with normal hemostasis during and after neurosurgery or lower abdominal surgery.
Claes
Y
Y
Department of Anesthesiology, University Hospitals of the Katholieke Universiteit, Leuven, Belgium.
Van Hemelrijck
J
J
Van Gerven
M
M
Arnout
J
J
Vermylen
J
J
Weidler
B
B
Van Aken
H
H
D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007044:Hysterectomy; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D010976:Platelet Count / Q000187:drug effects; D014841:von Willebrand Factor / Q000378:metabolism
D006895:Hydroxyethyl Starch Derivatives; D014841:von Willebrand Factor; D005340:Fibrinogen