Activity of blood coagulation and fibrinolysis during and after hydroxyethyl starch (HES) colloidal volume replacement.
OBJECTIVE
To examine the effect of medium molecular weight hydroxyethyl starch on protein C levels and the changes in the activation state of blood platelets, coagulation and fibrinolyis during and after 5 day of its infusion.


METHODS
Fifty male patients (mean age: 47 years, range 45-50 years) who required prostatectomy for benign prostatic hyperplasia were divided into two equal groups. One group was given 15 mL/kg body weight (mean volume 1000 mL +/- 100 mL) of 6% hydroxyethyl starch (HES) 200/0.5, the other received an equal volume of 5% human albumin during the operation. Blood samples were collected immediately before infusion (baseline values) and at 20, 40, 60, 90, 240, and 480 min after the infusion started then daily for the next 5 days postoperatively. Hematocrit, factor VIII:C, thrombin-antithrombin III complex; the anticoagulant protein C levels; the fibrinolytic parameters tissue type plasminogen activator (t-PA), and the fibrinolytic product D-Dimer and the platelet aggregation activity were measured.


RESULTS
The data obtained did not detect any significant differences between HES and human albumin in the plasma levels of thrombin-antithrombin III complex, protein C, tissue-type plasminogen activator and the fibrin split products D-Dimer. Factor VIII:C and platelet aggregation were significantly lower in the hydroxyethyl starch group in comparison with albumin. Baseline values were attained postoperatively for factor VIII:C and platelet aggregation by the first and fifth days, respectively.


CONCLUSIONS
The lowering effect of medium molecular weight hydroxyethyl starch on factor VIII:C would not be attributed to increased proteolytic activity of protein C on this coagulation cofactor because there is a nonsignificant change in protein C levels.
Omar
M N
MN
Biochemistry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Shouk
T A
TA
Khaleq
M A
MA
D000990:Antithrombin III / Q000378:metabolism; D001777:Blood Coagulation / Q000187:drug effects*; D019281:Dimerization; D005169:Factor VIII / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects*; D006400:Hematocrit; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000378:metabolism; D010974:Platelet Aggregation / Q000187:drug effects; D011486:Protein C / Q000378:metabolism; D010959:Tissue Plasminogen Activator / Q000378:metabolism
D006895:Hydroxyethyl Starch Derivatives; D011486:Protein C; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D005169:Factor VIII; D010447:Peptide Hydrolases; D010959:Tissue Plasminogen Activator