title: Effects on coagulation of balanced (130/0.42) and non-balanced (130/0.4) hydroxyethyl starch or gelatin compared with balanced Ringer's solution: an in vitro study using two different viscoelastic coagulation tests ROTEMTM and SONOCLOTTM.
abstract: BACKGROUND
  Hydroxyethyl starch (HES) solutions compromise blood coagulation. Low molecular weight, low-substituted HES products, and electrolyte-balanced solutions might reduce this effect. We compared the effects of in vitro haemodilution on blood coagulation with a balanced 6% HES 130/0.42 solution (HES(BAL)), a saline-based 6% HES 130/0.4 solution (HES(SAL)), a balanced lactated Ringer's solution (RL) and a saline-based 4% gelatin solution (GEL).
  
  
  METHODS
  Blood was obtained from 10 healthy male volunteers and diluted with the test solutions by 33% and 66%. Quality of clot formation was measured using two viscoelastic coagulation tests: SONOCLOT and activated rotation thromboelastometry ROTEM.
  
  
  RESULTS
  Of 16 parameters measured by the viscoelastic devices, we found three statistically significant differences compared with baseline for RL, but 11 for GEL, 10 for HES(SAL), and 11 for HES(BAL) in the 33% haemodilution group (P=0.01). Comparing the different solutions, we observed a significant difference between crystalloids and colloids but none between GEL and HES. In the 66% dilution group, effects on blood coagulation were increased when compared with the 33% dilution group. We found no differences in coagulation impairment between balanced and non-balanced HES products and no differences in the detection of impaired blood coagulation due to haemodilution between the two viscoelastic coagulation tests.
  
  
  CONCLUSIONS
  Both ROTEM and SONOCLOT are sensitive tests for the detection of impaired blood coagulation due to haemodilution. There are fewer effects on blood coagulation using crystalloids compared with colloids. The effects of GEL and HES are similar. There is no difference between balanced HES 130/0.42 and non-balanced HES 130/0.4.
authors.affiliation: Institute of Anesthesiology and Intensive Care, Kantonsspital Lucerne, Lucerne, Switzerland. mattias.casutt@ksl.ch
authors.forename: M
authors.initials: M
authors.lastname: Casutt
authors.forename: A
authors.initials: A
authors.lastname: Kristoffy
authors.forename: G
authors.initials: G
authors.lastname: Schuepfer
authors.forename: D R
authors.initials: DR
authors.lastname: Spahn
authors.forename: C
authors.initials: C
authors.lastname: Konrad
mesh_terms: D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests / Q000379:methods; D001809:Blood Viscosity / Q000187:drug effects; D005780:Gelatin / Q000494:pharmacology*; D006438:Hemodilution / Q000379:methods; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D066298:In Vitro Techniques; D007552:Isotonic Solutions / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000494:pharmacology*; D019095:Point-of-Care Systems; D000077331:Ringer's Solution; D013916:Thrombelastography / Q000379:methods
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077331:Ringer's Solution; D005780:Gelatin