Effects of PentaLyte and Voluven hemodilution on plasma coagulation kinetics in the rabbit: role of thrombin-fibrinogen and factor XIII-fibrin polymer interactions.
BACKGROUND
Hydroxyethyl starch (HES) administration has resulted in decreased hemostasis and fibrinogen (FI)-thrombin-(FIIa)-Factor XIII (FXIII) interactions. I proposed to determine the hemostatic effect of hemodilution with PentaLyte (6% HES, mean molecular weight 220 kDa) and Voluven (6% HES, 130 kDa).


METHODS
Rabbits were intravenously administered 20 ml/kg PentaLyte or Voluven (n = 8 per fluid) over 10 min. Plasma was obtained prior to, 1 min and 1 h after hemodilution. Thrombelastography was performed, with clot initiation (R, sec), clot propagation (alpha, degrees), and clot strength (shear elastic modulus, G, dynes/cm2) determined over 20 min. Celite-activated samples had either no additions or addition of FI, FIIa or activated FXIII (FXIIIa) to restore protein content to pre-diluted values.


CONCLUSIONS
While there were no significant differences between the groups, R significantly decreased 1 h after hemodilution compared with values observed before and 1 min after hemodilution, whereas alpha and G significantly decreased 1 min after hemodilution and then significantly, but only partially, increased 1 h after hemodilution compared with pre-dilution values. Addition of FI, FIIa and FXIIIa significantly decreased R in both groups. alpha and G 1 min after hemodilution were significantly enhanced by FI, FIIa, FXIIIa in both groups; however, 1 h after hemodilution, rabbits administered PentaLyte had alpha and G enhanced only by FI and FXIIIa addition, whereas animals administered Voluven had alpha and G significantly enhanced by FI addition. PentaLyte and Voluven hemodilution initially diminishes FIIa-FI and FXIIIa-fibrin, but within an hour primarily inhibit FXIIIa-fibrin interactions in the rabbit.
Nielsen
V G
VG
Department of Anesthesiology, The University of Alabama at Birmingham, Birmingham, AL 35249-6810, USA. vnielsen@uab.edu
D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects*; D001784:Blood Gas Analysis; D004573:Electrolytes; D005176:Factor XIII / Q000502:physiology*; D005337:Fibrin / Q000502:physiology*; D005340:Fibrinogen / Q000502:physiology*; D005947:Glucose; D006438:Hemodilution / Q000009:adverse effects*; D006439:Hemodynamics / Q000502:physiology; D006490:Hemostatics / Q000494:pharmacology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives; D066298:In Vitro Techniques; D007700:Kinetics; D008297:Male; D011817:Rabbits; D013916:Thrombelastography; D013917:Thrombin / Q000502:physiology*
D004573:Electrolytes; C485123:HES 130-0.4; D006490:Hemostatics; D006895:Hydroxyethyl Starch Derivatives; C112942:PentaLyte; D005337:Fibrin; D005340:Fibrinogen; D005176:Factor XIII; D013917:Thrombin; D005947:Glucose