A new plasma-adapted hydroxyethyl starch preparation: in vitro coagulation studies.
OBJECTIVE
Preparing hydroxyethyl starch (HES) in a plasma-adapted solution is supposed to improve safety with regard to coagulation. The influence of a new plasma-adapted HES preparation on coagulation was studied.


METHODS
Operator-blinded, randomized study.


METHODS
Laboratory in vitro study.


METHODS
Fifteen healthy young men scheduled for blood donation.


METHODS
Blood was diluted by 10%, 30%, and 50% using either a plasma-adapted or nonplasma-adapted (prepared in saline solution) potato-derived 6% HES 130/0.42. Only the composition of the solvent of the 2 HES preparations was different.


RESULTS
Rotation thromboelastometry (ROTEM; Pentapharm, Munich, Germany) was used to assess changes in coagulation; whole blood aggregometry with 3 inducers was used to assess effects of dilution with HES on platelet function. Clotting time (CT) and clot formation time were significantly prolonged by 30% and 50% dilution, showing significantly longer times in the non-plasma-adapted than in the plasma-adapted HES group (eg, intrinsic CT at the 30% dilution level: plasma-adapted HES 228 +/- 26 seconds [within normal range] v 269 +/- 29 seconds in the nonplasma-adapted HES group). Clot strengthening and clot firmness were significantly reduced by the non-plasma-adapted HES at the 30% dilution level. Platelet aggregation was significantly more reduced by the non-plasma-adapted HES at the 30% and 50% dilution levels.


CONCLUSIONS
Dilution with the nonplasma-adapted HES 130/0.42 was associated with more negative effects on thromboelastometry and platelet aggregation than the same HES 130/0.4 dissolved in a plasma-adapted solution. The benefits of using a plasma-adapted modern HES preparation on blood loss and use of blood/blood products in cardiac surgery need to be studied.
Boldt
Joachim
J
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. BoldtJ@gmx.net
Mengistu
Andinet
A
D000244:Adenosine Diphosphate / Q000494:pharmacology; D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D001792:Blood Platelets / Q000187:drug effects; D003018:Clot Retraction / Q000187:drug effects; D003094:Collagen / Q000494:pharmacology; D005340:Fibrinogen / Q000737:chemistry; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000737:chemistry / Q000494:pharmacology*; D008297:Male; D019999:Pharmaceutical Solutions; D010952:Plasma Substitutes / Q000737:chemistry / Q000494:pharmacology*; D010974:Platelet Aggregation / Q000187:drug effects; D010979:Platelet Function Tests; D013916:Thrombelastography; D014914:Whole Blood Coagulation Time
D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; D019999:Pharmaceutical Solutions; D010952:Plasma Substitutes; D000244:Adenosine Diphosphate; D005340:Fibrinogen; D003094:Collagen