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HES 200/0.5 is not HES 200/0.5. Influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics.
Thromb Haemost. 1995 Dec; 74(6):1452-6.TH

Abstract

The plasma clearance of hydroxyethyl starch (HES) depends on the initial molecular weight and the degree of substitution. So far, little attention has been paid to the clinical relevance of the C2/C6 substitution ratio of hydroxyethyl starch. 10 patients with cerebrovascular circulatory disturbance received hemodilution therapy for 10 days, consisting of 10% HES 200/0.5 (mean molecular weight 200 kD, degree of substitution 0.5) with a C2/C6 ratio of 13.4. A second group of 10 patients received a starch solution with identical initial molecular weight and degree of substitution but with a C2/C6 ratio of 5.7. After the administration of a single dose, no significant differences between the two groups were observed. After repeated administration, significant differences could be detected in hemorheology, coagulation and elimination (p < 0.01). The larger C2/C6 ratio led to a higher intravascular mean molecular weight (95 vs. 84 kD), which in turn led to a higher increase in serum concentration during the therapy (14.7 vs. 8.6 mg/ml). Hematocrit was lowered more (-30.5 vs. -23.5%) and plasma viscosity was increased more. There was also a more pronounced increase in partial thromboplastin time (+30% vs. +13%) and a factor of 2 larger decrease of factor VIII/von Willebrand factor-complex (p < 0.01), which exceeded the dilution effect. The higher C2/C6 ratio of HES 200/0.5/13.4 slows down enzymatic degradation. After repeated administration of this starch, large molecules accumulate which are inefficiently degraded. The same effect has been observed after therapy with highly-substituted HES. This accumulation of large molecules leads to a beneficial longer lasting volume effect. The disadvantages include an increase in plasma viscosity and coagulation disturbances, which cannot be explained with the respective dilution effect alone. For these reasons, the C2/C6 ratio is of clinical relevance and should be included in the product labeling in the future.

Authors+Show Affiliations

Department of Neurology, University of the Saarland, Hamburg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8772219

Citation

Treib, J, et al. "HES 200/0.5 Is Not HES 200/0.5. Influence of the C2/C6 Hydroxyethylation Ratio of Hydroxyethyl Starch (HES) On Hemorheology, Coagulation and Elimination Kinetics." Thrombosis and Haemostasis, vol. 74, no. 6, 1995, pp. 1452-6.
Treib J, Haass A, Pindur G, et al. HES 200/0.5 is not HES 200/0.5. Influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics. Thromb Haemost. 1995;74(6):1452-6.
Treib, J., Haass, A., Pindur, G., Seyfert, U. T., Treib, W., Grauer, M. T., Jung, F., Wenzel, E., & Schimrigk, K. (1995). HES 200/0.5 is not HES 200/0.5. Influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics. Thrombosis and Haemostasis, 74(6), 1452-6.
Treib J, et al. HES 200/0.5 Is Not HES 200/0.5. Influence of the C2/C6 Hydroxyethylation Ratio of Hydroxyethyl Starch (HES) On Hemorheology, Coagulation and Elimination Kinetics. Thromb Haemost. 1995;74(6):1452-6. PubMed PMID: 8772219.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HES 200/0.5 is not HES 200/0.5. Influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics. AU - Treib,J, AU - Haass,A, AU - Pindur,G, AU - Seyfert,U T, AU - Treib,W, AU - Grauer,M T, AU - Jung,F, AU - Wenzel,E, AU - Schimrigk,K, PY - 1995/12/1/pubmed PY - 1995/12/1/medline PY - 1995/12/1/entrez SP - 1452 EP - 6 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 74 IS - 6 N2 - The plasma clearance of hydroxyethyl starch (HES) depends on the initial molecular weight and the degree of substitution. So far, little attention has been paid to the clinical relevance of the C2/C6 substitution ratio of hydroxyethyl starch. 10 patients with cerebrovascular circulatory disturbance received hemodilution therapy for 10 days, consisting of 10% HES 200/0.5 (mean molecular weight 200 kD, degree of substitution 0.5) with a C2/C6 ratio of 13.4. A second group of 10 patients received a starch solution with identical initial molecular weight and degree of substitution but with a C2/C6 ratio of 5.7. After the administration of a single dose, no significant differences between the two groups were observed. After repeated administration, significant differences could be detected in hemorheology, coagulation and elimination (p < 0.01). The larger C2/C6 ratio led to a higher intravascular mean molecular weight (95 vs. 84 kD), which in turn led to a higher increase in serum concentration during the therapy (14.7 vs. 8.6 mg/ml). Hematocrit was lowered more (-30.5 vs. -23.5%) and plasma viscosity was increased more. There was also a more pronounced increase in partial thromboplastin time (+30% vs. +13%) and a factor of 2 larger decrease of factor VIII/von Willebrand factor-complex (p < 0.01), which exceeded the dilution effect. The higher C2/C6 ratio of HES 200/0.5/13.4 slows down enzymatic degradation. After repeated administration of this starch, large molecules accumulate which are inefficiently degraded. The same effect has been observed after therapy with highly-substituted HES. This accumulation of large molecules leads to a beneficial longer lasting volume effect. The disadvantages include an increase in plasma viscosity and coagulation disturbances, which cannot be explained with the respective dilution effect alone. For these reasons, the C2/C6 ratio is of clinical relevance and should be included in the product labeling in the future. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/8772219/HES_200/0_5_is_not_HES_200/0_5__Influence_of_the_C2/C6_hydroxyethylation_ratio_of_hydroxyethyl_starch__HES__on_hemorheology_coagulation_and_elimination_kinetics_ L2 - https://www.lens.org/lens/search/patent/list?q=citation_id:8772219 DB - PRIME DP - Unbound Medicine ER -