title: Does Hextend impair coagulation compared to 6% hetastarch? An ex vivo thromboelastography study.
abstract: The objective of this study was to determine if coagulation is different between 6% hetastarch in normal saline (NS) and 6% hetastarch in lactated Ringer's solution (LR), with use of an ex vivo thromboelastography (TEG) model with healthy donated volunteer blood. We simulated hemodilution that occurs during clinical resuscitation of hemorrhagic or hypovolemic shock, using healthy human donor whole blood (WB) ex vivo. Coagulopathy related to low, medium, high, or very high dilution of WB with NS or a high-molecular-weight hetastarch-based plasma expander, 6% hetastarch in NS (HSNS) or 6% hetastarch in lactated Ringer's [Hextend (HSLR)], was analyzed by thromboelastography (TEG). No changes were noted in the TEG profile of undiluted WB controls during the 6-hour period of use (P > 0.95). Dilution with HSNS and HSLR significantly impaired coagulation compared to both WB control and NS. Progressive dilution with NS impaired coagulation but to a lesser extent than colloids (P < 0.01). Low dilution of blood with NS increased clot strength by 12% (not significant; P = 0.097). We conclude that WB containing citrate obtained from healthy donors for TEG analysis yields reproducible data over a minimum of 6 hours. Either hetastarch, when present at concentrations comparable to the manufacturer's maximum recommended dose of 20 mL/kg (equivalent to the high dilution used in these experiments), decreases clot tensile strength to levels associated with an increased risk of bleeding. Substitution of lactated Ringer's for NS in 6% hetastarch appears to offer no advantage in avoiding hemostatic compromise in an in vitro model.
authors.affiliation: Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Weeks
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Jahr
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Lim
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Butch
authors.forename: Bernd
authors.initials: B
authors.lastname: Driessen
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D006438:Hemodilution; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology*; D066298:In Vitro Techniques; D007552:Isotonic Solutions / Q000737:chemistry; D014677:Pharmaceutical Vehicles / Q000737:chemistry; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000494:pharmacology*; D000077325:Ringer's Lactate; D012965:Sodium Chloride / Q000737:chemistry; D013718:Tensile Strength; D013916:Thrombelastography / Q000379:methods*; D013997:Time Factors
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D014677:Pharmaceutical Vehicles; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D012965:Sodium Chloride