A randomized, blinded trial comparing the hemostatic effects of pentastarch versus hetastarch.
BACKGROUND
HES solutions provide a sterile, alternative colloidal fluid to albumin solutions and/or plasma in the management of patients who need plasma volume expansion. Solutions of HES are widely accepted internationally but are used only modestly in the United States, largely because of concerns over hemostasis.


METHODS
A randomized, blinded, two-arm trial comparing the hemostatic effects of pentastarch versus hetastarch when infused in the clinically relevant dose of 90 g of HES dissolved in 1.5 L of saline was conducted. Multiple studies of fibrin clot formation, fibrinogen/fibrinolysis, and platelet (PLT) functions were performed before and on multiple occasions for 70 days following HES infusion.


RESULTS
Several significant abnormalities of hemostasis assay results occurred following HES infusions, with hetastarch causing significantly greater abnormalities than pentastarch. Individual clotting proteins and blood PLTs fell modestly because of plasma volume expansion and hemodilution. A fall in excess of that caused by hemodilution was demonstrated for von Willebrand factor antigen plus its associated FVIII and ristocetin cofactor activities. The partial thromboplastin time was prolonged, whereas the thrombin time was shortened. Plt function abnormalities were seen in most subjects to a modest degree. Studies of fibrinolysis were normal.


CONCLUSIONS
Solutions of hetastarch produce significant abnormalities of some hemostasis laboratory results when infused at clinically relevant doses, but it is unlikely that the modest hemostatic abnormalities produced at these doses per se would lead to clinical bleeding. Hetastarch causes greater hemostatic abnormalities than pentastarch, and because both HES solutions have comparable plasma volume-expanding effects, it is reasonable to prefer pentastarch as a plasma volume expander.
Strauss
Ronald G
RG
University of Iowa DeGowin Blood Center and the Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. ronald-strauss@uiowa.edu
Pennell
Beverly J
BJ
Stump
David C
DC
D000328:Adult; D001779:Blood Coagulation Factors / Q000032:analysis; D001780:Blood Coagulation Tests; D001798:Blood Proteins / Q000032:analysis; D001810:Blood Volume / Q000187:drug effects; D003018:Clot Retraction; D004311:Double-Blind Method; D006439:Hemodynamics / Q000187:drug effects; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D008970:Molecular Weight; D010952:Plasma Substitutes / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D010974:Platelet Aggregation / Q000187:drug effects; D010976:Platelet Count
D001779:Blood Coagulation Factors; D001798:Blood Proteins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes