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Gelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery.
Anesth Analg. 2006 Apr; 102(4):998-1006.A&A

Abstract

We investigated the effect of postoperative administration of colloids on hemostasis in 45 patients after cardiac surgery. Patients were randomized to receive 15 mL kg(-1) of either 4% albumin, 4% succinylated gelatin, or 6% hydroxyethyl starch (molecular weight of 200 kDa/degree of substitution 0.5) as a short-term infusion. There was a comparable decrease in maximum clot firmness of thromboelastometry tracings in gelatin and hydroxyethyl starch groups immediately after completion of the infusion, whereas these values remained unchanged in the albumin group. The impairment in clot strength persisted up to 2 h, although the values partly recovered. Postoperative bleeding correlated inversely with the clot strength in pooled data of the artificial colloids. Fibrin formation (clot formation time, alpha-angle) and fibrinogen-dependent clot strength (maximum clot firmness and shear elastic modulus) were more disturbed in the hydroxyethyl starch group than in the gelatin group. We conclude that after cardiopulmonary bypass surgery, both gelatin and hydroxyethyl starch impair clot strength and fibrin buildup, which may predispose patients to increased blood loss. The greatest impairment in hemostasis was seen after hydroxyethyl starch administration, whereas albumin appeared to have the least effect on hemostatic variables.

Authors+Show Affiliations

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

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16551888

Citation

Niemi, Tomi T., et al. "Gelatin and Hydroxyethyl Starch, but Not Albumin, Impair Hemostasis After Cardiac Surgery." Anesthesia and Analgesia, vol. 102, no. 4, 2006, pp. 998-1006.
Niemi TT, Suojaranta-Ylinen RT, Kukkonen SI, et al. Gelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery. Anesth Analg. 2006;102(4):998-1006.
Niemi, T. T., Suojaranta-Ylinen, R. T., Kukkonen, S. I., & Kuitunen, A. H. (2006). Gelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery. Anesthesia and Analgesia, 102(4), 998-1006.
Niemi TT, et al. Gelatin and Hydroxyethyl Starch, but Not Albumin, Impair Hemostasis After Cardiac Surgery. Anesth Analg. 2006;102(4):998-1006. PubMed PMID: 16551888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery. AU - Niemi,Tomi T, AU - Suojaranta-Ylinen,Raili T, AU - Kukkonen,Sinikka I, AU - Kuitunen,Anne H, PY - 2006/3/23/pubmed PY - 2006/4/14/medline PY - 2006/3/23/entrez SP - 998 EP - 1006 JF - Anesthesia and analgesia JO - Anesth Analg VL - 102 IS - 4 N2 - We investigated the effect of postoperative administration of colloids on hemostasis in 45 patients after cardiac surgery. Patients were randomized to receive 15 mL kg(-1) of either 4% albumin, 4% succinylated gelatin, or 6% hydroxyethyl starch (molecular weight of 200 kDa/degree of substitution 0.5) as a short-term infusion. There was a comparable decrease in maximum clot firmness of thromboelastometry tracings in gelatin and hydroxyethyl starch groups immediately after completion of the infusion, whereas these values remained unchanged in the albumin group. The impairment in clot strength persisted up to 2 h, although the values partly recovered. Postoperative bleeding correlated inversely with the clot strength in pooled data of the artificial colloids. Fibrin formation (clot formation time, alpha-angle) and fibrinogen-dependent clot strength (maximum clot firmness and shear elastic modulus) were more disturbed in the hydroxyethyl starch group than in the gelatin group. We conclude that after cardiopulmonary bypass surgery, both gelatin and hydroxyethyl starch impair clot strength and fibrin buildup, which may predispose patients to increased blood loss. The greatest impairment in hemostasis was seen after hydroxyethyl starch administration, whereas albumin appeared to have the least effect on hemostatic variables. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/16551888/Gelatin_and_hydroxyethyl_starch_but_not_albumin_impair_hemostasis_after_cardiac_surgery_ L2 - https://doi.org/10.1213/01.ane.0000200285.20510.b6 DB - PRIME DP - Unbound Medicine ER -