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Maize- or potato-derived hydroxyethyl starches: is there any thromboelastometric difference?
Acta Anaesthesiol Scand. 2010 Nov; 54(10):1241-7.AA

Abstract

BACKGROUND

Hydroxyethyl starches (HES) could differ with regard to the origin, and the influence on the coagulation of the raw material is unknown. This study compared the effects of a new potato-derived HES with a maize-derived HES and two crystalloid solutions.

METHODS

Whole blood from 10 healthy individuals was diluted by 20% and 40% using either non-balanced potato-derived HES 130/0.42/6:1, non-balanced maize-derived HES 130/0.4/9:1, isotonic saline or Ringer's lactate solution. Samples were analysed by thromboelastometry ROTEM(®) : Coagulation was initiated by acid ellagic [intrinsic thromboelastometry (INTEM)] or tissue factor (extrinsic thromboelastometry) with and without cytochalasin to determine the functional component of fibrinogen [cytochalasin-d-modified thromboelastometry (FIBTEM)]. Platelet count and fibrinogen activity were measured.

RESULTS

No effect of raw material was found as no difference was detected among the HES solutions. Whatever the solution, progressive haemodilution impaired haemostasis in a dose-dependant manner: For INTEM, the clot formation time was increased up to 308% and the maximum clot firmness (MCF) was decreased down to 49%. As dilution increased, initiation of coagulation was also impaired. Thromboelastometric alterations were more severe with HES than with crystalloids, especially regarding fibrin polymerization explorations: MCF of FIBTEM was considerably reduced from 12[10-14] to 2[2-3] mm (P<0.05). Fibrinogen activity and platelet count were reduced by dilution in a dose-dependant manner and decreased similarly in all groups.

CONCLUSION

Maize- and potato-derived HES have similar effects on coagulation. Both the starch preparations tested lead to more severe haemostatic defects than crystalloids, and impairment of fibrin polymerization appears to be a leading determinant of this coagulopathy.

Authors+Show Affiliations

Paris Descartes University, INSERM U, Paris, France. anne.godier@htd.aphp.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20840513

Citation

Godier, A, et al. "Maize- or Potato-derived Hydroxyethyl Starches: Is There Any Thromboelastometric Difference?" Acta Anaesthesiologica Scandinavica, vol. 54, no. 10, 2010, pp. 1241-7.
Godier A, Durand M, Smadja D, et al. Maize- or potato-derived hydroxyethyl starches: is there any thromboelastometric difference? Acta Anaesthesiol Scand. 2010;54(10):1241-7.
Godier, A., Durand, M., Smadja, D., Jeandel, T., Emmerich, J., & Samama, C. M. (2010). Maize- or potato-derived hydroxyethyl starches: is there any thromboelastometric difference? Acta Anaesthesiologica Scandinavica, 54(10), 1241-7. https://doi.org/10.1111/j.1399-6576.2010.02306.x
Godier A, et al. Maize- or Potato-derived Hydroxyethyl Starches: Is There Any Thromboelastometric Difference. Acta Anaesthesiol Scand. 2010;54(10):1241-7. PubMed PMID: 20840513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maize- or potato-derived hydroxyethyl starches: is there any thromboelastometric difference? AU - Godier,A, AU - Durand,M, AU - Smadja,D, AU - Jeandel,T, AU - Emmerich,J, AU - Samama,C M, Y1 - 2010/09/14/ PY - 2010/9/16/entrez PY - 2010/9/16/pubmed PY - 2011/2/9/medline SP - 1241 EP - 7 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 54 IS - 10 N2 - BACKGROUND: Hydroxyethyl starches (HES) could differ with regard to the origin, and the influence on the coagulation of the raw material is unknown. This study compared the effects of a new potato-derived HES with a maize-derived HES and two crystalloid solutions. METHODS: Whole blood from 10 healthy individuals was diluted by 20% and 40% using either non-balanced potato-derived HES 130/0.42/6:1, non-balanced maize-derived HES 130/0.4/9:1, isotonic saline or Ringer's lactate solution. Samples were analysed by thromboelastometry ROTEM(®) : Coagulation was initiated by acid ellagic [intrinsic thromboelastometry (INTEM)] or tissue factor (extrinsic thromboelastometry) with and without cytochalasin to determine the functional component of fibrinogen [cytochalasin-d-modified thromboelastometry (FIBTEM)]. Platelet count and fibrinogen activity were measured. RESULTS: No effect of raw material was found as no difference was detected among the HES solutions. Whatever the solution, progressive haemodilution impaired haemostasis in a dose-dependant manner: For INTEM, the clot formation time was increased up to 308% and the maximum clot firmness (MCF) was decreased down to 49%. As dilution increased, initiation of coagulation was also impaired. Thromboelastometric alterations were more severe with HES than with crystalloids, especially regarding fibrin polymerization explorations: MCF of FIBTEM was considerably reduced from 12[10-14] to 2[2-3] mm (P<0.05). Fibrinogen activity and platelet count were reduced by dilution in a dose-dependant manner and decreased similarly in all groups. CONCLUSION: Maize- and potato-derived HES have similar effects on coagulation. Both the starch preparations tested lead to more severe haemostatic defects than crystalloids, and impairment of fibrin polymerization appears to be a leading determinant of this coagulopathy. SN - 1399-6576 UR - https://www.unboundmedicine.com/medline/citation/20840513/Maize__or_potato_derived_hydroxyethyl_starches:_is_there_any_thromboelastometric_difference L2 - https://doi.org/10.1111/j.1399-6576.2010.02306.x DB - PRIME DP - Unbound Medicine ER -