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Artificial colloids impair haemostasis. An in vitro study using thromboelastometry coagulation analysis.
Acta Anaesthesiol Scand. 2005 Mar; 49(3):373-8.AA

Abstract

BACKGROUND

Hydroxyethyl starch (HES) solutions impair haemostatic mechanisms. The impact of the degree of substitution (DS) of a HES solution on thromboelastometry tracings is unclear. Therefore we tested the hypothesis of whether the DS has an effect on the haemostatic defect caused by HES, and assessed whole blood coagulation by thromboelastometry coagulation analysis (ROTEM, Pentapharm Co., Munich, Germany) in serial in vitro haemodilutions of colloids.

METHODS

Whole blood was withdrawn from 12 volunteers in a crossover study. Six per cent low-molecular weight HES with a high (HES MW 120 kDa/degree of substitution 0.7) and low (HES MW 130 kDa/0.4) degree of substitution, 4% succinylated gelatin (GEL) or 4% albumin (ALB) was added to citrated venous whole blood samples to make 20, 40, 60 vol.% end-concentrations of each of the solutions. Samples were analyzed by ROTEM.

RESULTS

There was a comparable decrease in maximum clot firmness (MCF) and shear elastic modulus [G = 5000 x MCF/(100-MCF)] by HES 120/0.7 and HES 130/0.4 at 20 and 40 vol.% dilutions. At 60 vol.% dilution HES 120/0.7 decreased less alpha-angle and MCF than HES 130/0.4 (P < 0.05). With moderate dilutions all colloids shortened coagulation time (CT). At 20, 40 and 60 vol.% dilutions MCF and G were more decreased in both HES groups than in the ALB and GEL groups (P < 0.05). Furthermore, at 40 and 60 vol.% dilutions G deteriorated more in the GEL than in the ALB group (P < 0.05).

CONCLUSION

In vitro the impact of the degree of substitution of HES solution on thromboelastometry coagulation analysis was modest. Haemodilution with gelatin and albumin induced fewer coagulation abnormalities than HES. In addition, the haemodilution with gelatin impaired coagulation more than albumin solution.

Authors+Show Affiliations

Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. tomi.niemi@hus.fiNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

15752404

Citation

Niemi, T T., and A H. Kuitunen. "Artificial Colloids Impair Haemostasis. an in Vitro Study Using Thromboelastometry Coagulation Analysis." Acta Anaesthesiologica Scandinavica, vol. 49, no. 3, 2005, pp. 373-8.
Niemi TT, Kuitunen AH. Artificial colloids impair haemostasis. An in vitro study using thromboelastometry coagulation analysis. Acta Anaesthesiol Scand. 2005;49(3):373-8.
Niemi, T. T., & Kuitunen, A. H. (2005). Artificial colloids impair haemostasis. An in vitro study using thromboelastometry coagulation analysis. Acta Anaesthesiologica Scandinavica, 49(3), 373-8.
Niemi TT, Kuitunen AH. Artificial Colloids Impair Haemostasis. an in Vitro Study Using Thromboelastometry Coagulation Analysis. Acta Anaesthesiol Scand. 2005;49(3):373-8. PubMed PMID: 15752404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Artificial colloids impair haemostasis. An in vitro study using thromboelastometry coagulation analysis. AU - Niemi,T T, AU - Kuitunen,A H, PY - 2005/3/9/pubmed PY - 2005/9/24/medline PY - 2005/3/9/entrez SP - 373 EP - 8 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 49 IS - 3 N2 - BACKGROUND: Hydroxyethyl starch (HES) solutions impair haemostatic mechanisms. The impact of the degree of substitution (DS) of a HES solution on thromboelastometry tracings is unclear. Therefore we tested the hypothesis of whether the DS has an effect on the haemostatic defect caused by HES, and assessed whole blood coagulation by thromboelastometry coagulation analysis (ROTEM, Pentapharm Co., Munich, Germany) in serial in vitro haemodilutions of colloids. METHODS: Whole blood was withdrawn from 12 volunteers in a crossover study. Six per cent low-molecular weight HES with a high (HES MW 120 kDa/degree of substitution 0.7) and low (HES MW 130 kDa/0.4) degree of substitution, 4% succinylated gelatin (GEL) or 4% albumin (ALB) was added to citrated venous whole blood samples to make 20, 40, 60 vol.% end-concentrations of each of the solutions. Samples were analyzed by ROTEM. RESULTS: There was a comparable decrease in maximum clot firmness (MCF) and shear elastic modulus [G = 5000 x MCF/(100-MCF)] by HES 120/0.7 and HES 130/0.4 at 20 and 40 vol.% dilutions. At 60 vol.% dilution HES 120/0.7 decreased less alpha-angle and MCF than HES 130/0.4 (P < 0.05). With moderate dilutions all colloids shortened coagulation time (CT). At 20, 40 and 60 vol.% dilutions MCF and G were more decreased in both HES groups than in the ALB and GEL groups (P < 0.05). Furthermore, at 40 and 60 vol.% dilutions G deteriorated more in the GEL than in the ALB group (P < 0.05). CONCLUSION: In vitro the impact of the degree of substitution of HES solution on thromboelastometry coagulation analysis was modest. Haemodilution with gelatin and albumin induced fewer coagulation abnormalities than HES. In addition, the haemodilution with gelatin impaired coagulation more than albumin solution. SN - 0001-5172 UR - https://www.unboundmedicine.com/medline/citation/15752404/Artificial_colloids_impair_haemostasis__An_in_vitro_study_using_thromboelastometry_coagulation_analysis_ L2 - https://doi.org/10.1111/j.1399-6576.2005.00619.x DB - PRIME DP - Unbound Medicine ER -