title: The impact of balanced hydroxylethyl starch cardiopulmonary bypass priming solution on the fibrin part of clot formation: ex vivo rotation thromboelastometry.
abstract: BACKGROUND
  Balanced colloidal priming solutions are supposed to further minimize the effects of cardiopulmonary bypass (CPB) on haemostasis as compared to gelatin-based preparations. This exploratory study investigated whether clot formation, in particular the fibrin part of the clot, is less altered by a modern balanced HES solution as compared to a gelatin-based priming solution.
  
  
  METHODS
  CPB priming solutions containing 60% gelatin (Gelofusin®) or balanced HES starch (100% or 60% Tetraspan®) were mixed with blood samples from healthy volunteers and compared with respect to their impact on clotting time (CT), alpha angle, maximum clot firmness (MCF), and fibrinogen, using thromboelastometry.
  
  
  RESULTS
  The 100% and 60% HES priming solutions significantly increased the EXTEM CT from 66 ± 9 s to 82 ± 19 and 83 ± 13, respectively (both P<0.05 vs. baseline). The speed of solid clot formation decreased significantly for all priming solutions compared with baseline values. The INTEM MCF decreased from 59 ± 4 mm to 47 ± 4, 44 ± 4 and 43 ± 3 mm, whereas the EXTEM MCF decreased from 57 ± 4 mm to 51 ± 4, 51 ± 4 and 50 ± 4 mm after dilution with 60% gelatin, 100% HES or 60% HES priming solution, respectively (all P<0.01 vs. baseline). The priming solutions containing HES induced the largest decrease in MCF attributed to fibrinogen from 12 ± 3 mm to 4 ± 4 mm and 3 ± 2 mm (both P<0.05) for the 100% and mixed priming solution, respectively.
  
  
  CONCLUSIONS
  Ex vivo rotation thromboelastometry did not reveal the expected preservation of coagulation parameters, in particular the fibrin part of clot formation, by a balanced HES priming solution.
authors.affiliation: Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, Amsterdam, the Netherlands.
authors.forename: Marly H
authors.initials: MH
authors.lastname: Appelman
authors.forename: Lerau J M
authors.initials: LJ
authors.lastname: van Barneveld
authors.forename: Johannes W A
authors.initials: JW
authors.lastname: Romijn
authors.forename: Alexander B A
authors.initials: AB
authors.lastname: Vonk
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
mesh_terms: D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass; D005260:Female; D005337:Fibrin / Q000032:analysis / Q000378:metabolism*; D005780:Gelatin / Q000494:pharmacology; D006488:Hemostasis, Surgical; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D008297:Male; D010952:Plasma Substitutes / Q000494:pharmacology*; D013916:Thrombelastography
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D005780:Gelatin; D005337:Fibrin