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Rapidly degradable hydroxyethyl starch solutions impair blood coagulation after cardiac surgery: a prospective randomized trial.
Anesth Analg. 2009 Jan; 108(1):30-6.A&A

Abstract

BACKGROUND

There is continuing concern about the effect of hydroxyethyl starch (HES) solutions on blood coagulation. Rapidly degradable HES solutions with more favorable effects on clot strength have therefore been developed. Because the risk of bleeding is increased after cardiopulmonary bypass, we examined whether these types of HES solutions could be administered after cardiac surgery without an alteration of coagulation.

METHODS

Two new rapidly degradable HES solutions were compared with human albumin in 45 patients scheduled for elective primary cardiac surgery. After admission to the cardiac surgical intensive care unit, the patients were allocated in random order to receive either 15 mL/kg of HES solution with low molecular weight and low molar substitution (either 6% HES200/0.5 or 6% HES130/0.4) or 4% human albumin solution as a short-time (70-240 min) infusion.

RESULTS

Clot formation time was prolonged and maximum clot firmness was decreased in thromboelastometry tracings after infusion of both HES solutions. This impairment in thromboelastometry tracings partly recovered (using InTEM and ExTEM coagulation activators) at 2 h after the completion of the study infusion. Platelet contribution to maximum clot firmness remained unaffected in all of the study groups. HES did not induce fibrinolysis. No changes in thromboelastometry tracings were observed after human albumin infusion. Chest tube drainage was comparable in the study groups.

CONCLUSIONS

We conclude that a short-time infusion of rapidly degradable HES solutions after cardiac surgery produces impairment in fibrin formation and clot strength in thromboelastometry tracings. In this clinical setting, human albumin does not impair hemostasis.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Meilahti Hospital, Helsinki, Finland. alexey.schramko@hus.fNo affiliation info availableNo 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

19095827

Citation

Schramko, Alexey A., et al. "Rapidly Degradable Hydroxyethyl Starch Solutions Impair Blood Coagulation After Cardiac Surgery: a Prospective Randomized Trial." Anesthesia and Analgesia, vol. 108, no. 1, 2009, pp. 30-6.
Schramko AA, Suojaranta-Ylinen RT, Kuitunen AH, et al. Rapidly degradable hydroxyethyl starch solutions impair blood coagulation after cardiac surgery: a prospective randomized trial. Anesth Analg. 2009;108(1):30-6.
Schramko, A. A., Suojaranta-Ylinen, R. T., Kuitunen, A. H., Kukkonen, S. I., & Niemi, T. T. (2009). Rapidly degradable hydroxyethyl starch solutions impair blood coagulation after cardiac surgery: a prospective randomized trial. Anesthesia and Analgesia, 108(1), 30-6. https://doi.org/10.1213/ane.0b013e31818c1282
Schramko AA, et al. Rapidly Degradable Hydroxyethyl Starch Solutions Impair Blood Coagulation After Cardiac Surgery: a Prospective Randomized Trial. Anesth Analg. 2009;108(1):30-6. PubMed PMID: 19095827.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapidly degradable hydroxyethyl starch solutions impair blood coagulation after cardiac surgery: a prospective randomized trial. AU - Schramko,Alexey A, AU - Suojaranta-Ylinen,Raili T, AU - Kuitunen,Anne H, AU - Kukkonen,Sinikka I, AU - Niemi,Tomi T, PY - 2008/12/20/entrez PY - 2008/12/20/pubmed PY - 2009/1/22/medline SP - 30 EP - 6 JF - Anesthesia and analgesia JO - Anesth Analg VL - 108 IS - 1 N2 - BACKGROUND: There is continuing concern about the effect of hydroxyethyl starch (HES) solutions on blood coagulation. Rapidly degradable HES solutions with more favorable effects on clot strength have therefore been developed. Because the risk of bleeding is increased after cardiopulmonary bypass, we examined whether these types of HES solutions could be administered after cardiac surgery without an alteration of coagulation. METHODS: Two new rapidly degradable HES solutions were compared with human albumin in 45 patients scheduled for elective primary cardiac surgery. After admission to the cardiac surgical intensive care unit, the patients were allocated in random order to receive either 15 mL/kg of HES solution with low molecular weight and low molar substitution (either 6% HES200/0.5 or 6% HES130/0.4) or 4% human albumin solution as a short-time (70-240 min) infusion. RESULTS: Clot formation time was prolonged and maximum clot firmness was decreased in thromboelastometry tracings after infusion of both HES solutions. This impairment in thromboelastometry tracings partly recovered (using InTEM and ExTEM coagulation activators) at 2 h after the completion of the study infusion. Platelet contribution to maximum clot firmness remained unaffected in all of the study groups. HES did not induce fibrinolysis. No changes in thromboelastometry tracings were observed after human albumin infusion. Chest tube drainage was comparable in the study groups. CONCLUSIONS: We conclude that a short-time infusion of rapidly degradable HES solutions after cardiac surgery produces impairment in fibrin formation and clot strength in thromboelastometry tracings. In this clinical setting, human albumin does not impair hemostasis. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19095827/Rapidly_degradable_hydroxyethyl_starch_solutions_impair_blood_coagulation_after_cardiac_surgery:_a_prospective_randomized_trial_ L2 - https://doi.org/10.1213/ane.0b013e31818c1282 DB - PRIME DP - Unbound Medicine ER -