title: HES 130/0.4 impairs haemostasis and stimulates pro-inflammatory blood platelet function.
abstract: BACKGROUND
  Hydroxyethyl starch (HES) solutions are widely used for volume replacement therapy but are also known to compromise coagulation, impair renal function and increase long-term mortality. To test the hypotheses that HES 130/0.4 has fewer adverse effects than HES 200/0.5 and exerts anti-inflammatory properties, we compared the effects of HES 130/0.4, HES 200/0.5 and saline on in vitro haemostasis and pro-inflammatory platelet function.
  
  
  METHODS
  Whole blood samples from healthy volunteers were mixed with 6% HES 130/0.4, 10% HES 200/0.5, or normal saline to achieve a final haemodilution rate of 10% or 40%. Haemostatic capacity was characterised by thromboelastography (ROTEM) and measurement for FXIIIa activity. Platelet activation and pro-inflammatory platelet functions were characterised by flow cytometry measuring the platelet activation marker CD62P and binding of fibrinogen to platelets as well as the formation of heterotypic platelet-leukocyte conjugates.
  
  
  RESULTS
  Compared with saline, HES 130/0.4 dose-dependently impaired formation and firmness of the fibrin clot but did not affect the fibrin crosslinking activity of FXIIIa. At 40% but not at 10% haemodilution rate, HES 200/0.5 also increased platelet fibrinogen binding and both HES solutions increased expression of CD62P, the main receptor for platelet-leukocyte adhesion. HES 130/0.4 but not HES 200/0.5 increased formation of platelet-neutrophil conjugates and, to a lesser degree, platelet-monocyte conjugates.
  
  
  CONCLUSIONS
  Our data demonstrate that HES 130/0.4 has similar adverse effects as HES 200/0.5. In particular, both types of HES impair coagulation capacity and stimulate, rather than attenuate, pro-inflammatory platelet function.
authors.affiliation: Department of Anaesthesiology and Intensive Care Therapy, Jena University Hospital, D-07740 Jena, Germany. maik.sossdorf@med.uni-jena.de
authors.forename: Maik
authors.initials: M
authors.lastname: Sossdorf
authors.forename: Sascha
authors.initials: S
authors.lastname: Marx
authors.forename: Barbara
authors.initials: B
authors.lastname: Schaarschmidt
authors.forename: Gordon P
authors.initials: GP
authors.lastname: Otto
authors.forename: Ralf A
authors.initials: RA
authors.lastname: Claus
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hartog
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lösche
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects*; D001792:Blood Platelets / Q000166:cytology / Q000187:drug effects / Q000502:physiology*; D005176:Factor XIII / Q000187:drug effects / Q000502:physiology; D006438:Hemodilution; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000494:pharmacology*; D007249:Inflammation / Q000503:physiopathology / Q000517:prevention & control; D015539:Platelet Activation / Q000187:drug effects*; D013916:Thrombelastography
chemical_list: C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D005176:Factor XIII