DOI: 10.1097/01.SA.0000365058.28476.56
,
Issn Print: 0039-6206
Publication Date: 2010/02/01
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Excerpt
Alexey A. Schramko, Raili T. Suojaranta-Ylinen, Anne H. Kuitunen, Sinikka I. Kukkonen, and Tomi T. Niemi
(Anesth Analg, 108:30-36, 2009)
Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Meilahti Hospital, Helsinki, Finland.
All hydroxyethyl starch (HES) solutions alter blood coagulation as measured by thromboelastometry, decreased clot strength, and prolonged clot formation. Because of concerns raised about HES, rapidly degradable HES solutions with better effects on clot strength have been developed. This prospective, randomized study assessed the effects of these HES solutions on 45 patients after elective cardiac surgery.
After cardiac surgery with cardiopulmonary bypass using a standard protocol, patients were admitted to the cardiac surgical intensive care unit and allocated to receive either 15 mL/kg with low molecular weight and low molar substitution (6% HES 200/0.5 or 6% HES 130/0.4) or 4% human albumin (HA) solution as an infusion over 70 to 240 minutes. The infusion rate was adjusted to keep the pulmonary artery wedge pressure at 10 to 14 mm Hg and the cardiac index greater than 2.0 L/min per meter squared. The hemoglobin level was kept at greater than 8.0 g/dL with infusions of packed red blood cells (RBCs), if required.
The 3 groups were similar in demographic characteristics and preoperative data. Two patients in the HES 200/0.5 and 2 in the HA group required transfusions of packed RBC during cardiopulmonary bypass. The median infusion times were 100 minutes in the HES 130/0.4, 105 minutes in the HES 200/0.5, and 95 minutes in the HA groups. Low-output syndrome was not seen during the first postoperative day in any study patients, nor did the number of patient receiving low-dose norepinephrine or epinephrine differ among the groups. Baseline thromboelastometry parameters were similar in the groups. In both HES groups, an equal decrease in α-angle and prolongation in clot formation time were observed immediately after the infusion was finished, and for 2 hours thereafter; these parameters were unchanged in the HA group. Maximum clot firmness and shear elastic modulus were decreased in thromboelastometry tracings with both HES solutions. These results were still impaired 2 hours after completion of the infusion. Human albumin had no effect on either clot firmness or shear elastic modulus. Platelet maximum clot firmness was unchanged in all groups. Clot lysis parameters were within reference ranges and did not differ among the 3 groups. The hemoglobin concentration and hematocrit postoperatively were similar in all 3 groups; after the infusion was administered, they decreased substantially and were higher in the HA group compared with both HES groups. No differences were found in the amount of packed RBC concentrates, fresh frozen plasma, or platelet concentrates administered postoperatively. The investigators concluded that both HES solutions impaired fibrin formation and clot strength in patients after cardiac surgery; but HA did not impair hemostasis.
