Balanced hydroxyethylstarch preparations: are they all the same? In-vitro thrombelastometry and whole blood aggregometry.
OBJECTIVE
Haemostasis appears to be less altered with balanced than with unbalanced hydroxyethylstarch (HES) preparations. In a blinded in-vitro coagulation study, the effects of two HESs dissolved in different balanced solutions were measured.


METHODS
Blood from 12 healthy young male volunteers was diluted by 10, 30 and 50% by using either a balanced 6% HES 130/0.42 or a balanced 6% HES 130/0.4. Composition of the solvent of the two HES preparations differed. An unbalanced gelatin solution was used as a control. Rotation thrombelastometry was used to assess changes in coagulation, and whole blood aggregometry using three different inductors was used to assess the effects of dilution on platelet function.


RESULTS
Dilutions of 10 and 30% showed no significant changes in thrombelastometry data and platelet aggregation in all three groups. Fifty per cent haemodilution was associated with significantly more pronounced deterioration in clotting time, clot formation time and clot firmness, with the balanced HES 130/0.42 containing calcium than with the balanced HES without calcium. Platelet function was also more impaired by HES not containing calcium than by HES containing calcium. Extreme dilution with gelatin showed similar results to those of balanced HES 130/0.4.


CONCLUSIONS
Our in-vitro studies showed that extreme haemodilution with HES 130/0.42 dissolved in a balanced solution containing calcium was associated with less negative effects on thrombelastometry and platelet aggregation than HES 130/0.4 prepared in a balanced solution without calcium. Gelatin prepared in a nonbalanced solution showed similar effects on coagulation to balanced HES without calcium.
Boldt
Joachim
J
Department of Anaesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. BoldtJ@gmx.net
Mengistu
Andinet
A
D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D005780:Gelatin / Q000494:pharmacology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology*; D066298:In Vitro Techniques; D008297:Male; D008970:Molecular Weight; D010974:Platelet Aggregation / Q000187:drug effects*; D010979:Platelet Function Tests / Q000379:methods; D013916:Thrombelastography / Q000379:methods*; D016896:Treatment Outcome; D014914:Whole Blood Coagulation Time
D006895:Hydroxyethyl Starch Derivatives; D005780:Gelatin