title: A new plasma-adapted hydroxyethylstarch preparation: in vitro coagulation studies using thrombelastography and whole blood aggregometry.
abstract: BACKGROUND
  The lack of acceptance of hydroxyethylstarch (HES) for intravascular volume replacement is most likely due to reports of abnormal coagulation. In a blinded in vitro study, we compared the effects on hemostasis of a new HES, prepared in a balanced solution, with a conventional HES preparation and Ringer's lactate solution.
  
  
  METHODS
  Blood was taken from 10 healthy young male volunteers. Blood was diluted by 10%, 30%, and 50% using either 6% HES 130/0.42 prepared in a balanced solution, a conventional nonbalanced 6% HES 130/0.4 or Ringer's lactate solution. Rotation thrombelastography, was performed after adding two activators (thromboplastin-phospholipid to monitor the intrinsic system; tissue factor to monitor the extrinsic system). Whole blood aggregometry adding adenosine diphosphate, collagen, and thrombin receptor-activating protein was used to assess changes of platelet function.
  
  
  RESULTS
  Dilution of blood (30% and 50%) resulted in clot formation time that was significantly more prolonged in the nonbalanced than in the balanced HES group. In the 50% diluted sample using the unbalanced HES, maximum clot firmness was significantly more reduced than by 50% dilution using the balanced HES. In the 50% diluent using the nonbalanced HES, adenosine diphosphate-, collagen-, and thrombin receptor activating protein-induced aggregometry was more reduced than in the balanced HES group.
  
  
  CONCLUSIONS
  A balanced HES preparation showed fewer negative effects on thrombelastographic data and platelet aggregation than a nonbalanced HES preparation, especially when using higher degrees of dilution. Future clinical studies may show a decreased influence of balanced HES solutions on coagulation.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. boldtj@gmx.net
authors.forename: Joachim
authors.initials: J
authors.lastname: Boldt
authors.forename: Michael
authors.initials: M
authors.lastname: Wolf
authors.forename: Andinet
authors.initials: A
authors.lastname: Mengistu
mesh_terms: D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects* / Q000502:physiology; D001780:Blood Coagulation Tests / Q000379:methods; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000737:chemistry / Q000494:pharmacology*; D008297:Male; D010974:Platelet Aggregation / Q000187:drug effects* / Q000502:physiology; D010976:Platelet Count / Q000379:methods; D013916:Thrombelastography / Q000379:methods*; D014914:Whole Blood Coagulation Time / Q000379:methods*
chemical_list: D006895:Hydroxyethyl Starch Derivatives