title: Compromised blood coagulation: an in vitro comparison of hydroxyethyl starch 130/0.4 and hydroxyethyl starch 200/0.5 using thrombelastography.
abstract: We compared the effects of progressive in vitro hemodilution (30% and 60%) on blood coagulation in 80 patients receiving one of two different 6% hydroxyethyl starch (HES) solutions using thrombelastography (TEG). The newly developed solution has a mean molecular weight of 130 kD and a degree of substitution, defined as the average number of hydroxyethyl groups per glucose moiety, of 0.4 (HES 130/0.4); the conventional solution has a mean molecular weight of 200 kD and a degree of substitution of 0.5 (HES 200/0.5). Both HES solutions significantly compromised blood coagulation, as seen by an increase in reaction time and coagulation time and a decrease in angle alpha, maximal amplitude, and coagulation index (all P < 0.05). There was no difference between HES 130/0.4 and HES 200/0.5 diluted blood (P > 0.05 for all TEG variables). When analyzing the intrinsic HES effect by taking hemodilution with 0.9% saline into account, progressive hemodilution with both HES solutions resulted in an increasing clot lysis (P < 0.05 after 60 min). Again, there was no difference between HES 130/0.4 and HES 200/0.5 diluted blood. We conclude that HES 130/ 0.4 and HES 200/0.5 compromise blood coagulation to the same degree.
  
  
  CONCLUSIONS
  Progressive in vitro hemodilution using hydroxyethyl starch (HES) compromises blood coagulation. We observed similar effects of a new HES solution with a mean molecular weight of 130 kD and a degree of substitution of 0.4 (HES 130/0.4), compared with the conventional HES 200/0.5.
authors.affiliation: Institute of Anesthesiology, University Hospital, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Jamnicki
authors.forename: A
authors.initials: A
authors.lastname: Zollinger
authors.forename: B
authors.initials: B
authors.lastname: Seifert
authors.forename: D
authors.initials: D
authors.lastname: Popovic
authors.forename: T
authors.initials: T
authors.lastname: Pasch
authors.forename: D R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects*; D002118:Calcium / Q000097:blood; D005260:Female; D006438:Hemodilution; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000494:pharmacology*; D013916:Thrombelastography / Q000187:drug effects*; D014914:Whole Blood Coagulation Time
chemical_list: D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D002118:Calcium