Does OxyVita, a new-generation hemoglobin-based oxygen carrier, or oxyglobin acutely interfere with coagulation compared with normal saline or 6% hetastarch? An ex vivo thromboelastography study.
OBJECTIVE
Because hetastarches have deleterious effects on coagulation that increase with molecular weight (MWt), risk of coagulopathy associated with a high MWt hemoglobin-based oxygen carrier (HBOC) was studied.


METHODS
Preliminary laboratory study of donor blood using thromboelastography (TEG).


METHODS
University laboratory.


METHODS
Volunteer donor blood.


METHODS
Experiments simulated hemodilution during clinical resuscitation of hemorrhagic shock with varying doses of HBOCs. Coagulopathy related to 1:11, 1:5, 1:2, or 1:1 dilution of whole blood with normal saline, 6% hetastarch (670 kilodaltons [kD]), hemoglobin glutamer-200 (HBOC-200, 200 kD), or OxyVita (OXYVITA Inc, New Windsor, NY) (a new-generation, zero-link polymerized bovine hemoglobin-based oxygen carrier, 33 megadaltons) were analyzed.


RESULTS
At 2 lower levels of hemodilution, hetastarch, HBOC-200, and OxyVita produced equivalent reductions in maximum clot strength (TEG-MA and TEG-G) that reached statistical significance compared with whole blood and normal saline. At 2 higher dilutions, OxyVita and HBOC-200 impaired maximum clot strength compared with whole blood, normal saline, and hetastarch. Dilution with hetastarch had a greater effect on clot propagation (K and alpha) than either HBOC.


CONCLUSIONS
OxyVita and HBOC-200, HBOCs with different MWt, had similar effects on coagulation as measured by TEG. The impairment of coagulation by HBOCs and hetastarch occurred at doses corresponding to 12 mL/kg or a blood volume replacement of 17%. The use of HBOCs at doses corresponding to 23 mL/kg or a blood volume replacement of 33% significantly decreased coagulation to levels associated with increased clinical bleeding in this preliminary study. Minimal coagulopathic effects are expected with use of OxyVita at the manufacturer's anticipated effective dose of 10 g or 2 to 3 mL/kg.
Jahr
Jonathan S
JS
Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. jsjahr@mednet.ucla.edu
Weeks
David L
DL
Desai
Poonam
P
Lim
Jennifer C
JC
Butch
Anthony W
AW
Gunther
Robert
R
Driessen
Bernd
B
D001777:Blood Coagulation / Q000187:drug effects*; D001802:Blood Substitutes / Q000008:administration & dosage / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D006454:Hemoglobins / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology; D012771:Shock, Hemorrhagic / Q000097:blood / Q000628:therapy; D012965:Sodium Chloride / Q000494:pharmacology; D013916:Thrombelastography / Q000187:drug effects*
D001802:Blood Substitutes; D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; C529085:OxyVita; C402601:hemoglobin glutamer-200; D012965:Sodium Chloride