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Changes in blood coagulation after colloid administration in patients undergoing total hip arthroplasty: comparison between pentastarch and tetrastarches, a randomized trial.

Shin HJ, Na HS, Jeon YT, Lee GW, Do SH - Korean J Anesthesiol (2015)

Bottom Line: The percentage change in the FIBTEM maximum clot firmness was greatest in Group-PEN (P = 0.011).The international normalized ratio of prothrombin time (P < 0.001) and the activated partial thromboplastin time (P < 0.001) were significantly prolonged in Group-PEN compared to those of Group-TETB.No differences in hemostatic profile were observed between the balanced electrolyte and saline-based 6% HES 130/0.4.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

ABSTRACT

Background: Hydroxyethyl starch (HES) solutions are used as plasma expanders for correcting hypovolemia, but can lead to impaired coagulation. We evaluated the changes in hematological and hemostatic profiles with three types of HES.

Methods: Patients were randomized to receive volume replacement with 10% pentastarch 260/0.45 in 0.9% saline (Group-PEN, n = 25), 6% tetrastarch 130/0.4 in 0.9% saline (Group-TETS, n = 25), or 6% tetrastarch 130/0.4 in a balanced electrolyte solution (Group-TETB, n = 25). Coagulation was assessed using rotational thromboelastometry (ROTEM®) and other laboratory tests were performed, including measurements of hematological and hemostatic parameters and electrolytes.

Results: Post-operative ROTEM® parameters changed toward hypocoagulable states in all groups. The post-operative parameters of EXTEM and FIBTEM were more impaired in Group-PEN than in Group-TETB. The percentage change in INTEM clot formation time (P = 0.004) and α-angle (P = 0.003) were smaller in Group-TETS and Group-TETB than in Group-PEN. The percentage change in the FIBTEM maximum clot firmness was greatest in Group-PEN (P = 0.011). The international normalized ratio of prothrombin time (P < 0.001) and the activated partial thromboplastin time (P < 0.001) were significantly prolonged in Group-PEN compared to those of Group-TETB.

Conclusions: The 6% HES 130/0.4 in a balanced electrolyte solution seemed to have less of an impact on blood coagulation than the 10% HES 260/0.45. No differences in hemostatic profile were observed between the balanced electrolyte and saline-based 6% HES 130/0.4.

No MeSH data available.


Algorithm for intra-operative colloid replacement. SAP: systolic arterial pressure, HR: heart rate, Hct: hematocrit.
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Figure 1: Algorithm for intra-operative colloid replacement. SAP: systolic arterial pressure, HR: heart rate, Hct: hematocrit.

Mentions: All patients received a colloid to treat hypovolemia according to a volume replacement algorithm based on the method described by Gan et al. [3] (Fig. 1). If the intra-operative hematocrit value fell below 27%, packed RBCs were transfused as necessary. Fresh frozen plasma (FFP) was administered post-operatively to patients who had both a FIBTEM-MCF value < 5 mm and prolonged coagulation test results (PT-INR > 1.30, aPTT > 50 s). Ringer's lactate solution was used to maintain fluid volume during the operation at a rate of 5 ml/kg/h. When the hemodynamic target was not attained despite adequate intravascular volume replacement, we considered circulatory support with vasopressors. In the present study, the maximum allowable dose of HES was 20 ml/kg to prevent the adverse effects of HES solution.


Changes in blood coagulation after colloid administration in patients undergoing total hip arthroplasty: comparison between pentastarch and tetrastarches, a randomized trial.

Shin HJ, Na HS, Jeon YT, Lee GW, Do SH - Korean J Anesthesiol (2015)

Algorithm for intra-operative colloid replacement. SAP: systolic arterial pressure, HR: heart rate, Hct: hematocrit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4524935&req=5

Figure 1: Algorithm for intra-operative colloid replacement. SAP: systolic arterial pressure, HR: heart rate, Hct: hematocrit.
Mentions: All patients received a colloid to treat hypovolemia according to a volume replacement algorithm based on the method described by Gan et al. [3] (Fig. 1). If the intra-operative hematocrit value fell below 27%, packed RBCs were transfused as necessary. Fresh frozen plasma (FFP) was administered post-operatively to patients who had both a FIBTEM-MCF value < 5 mm and prolonged coagulation test results (PT-INR > 1.30, aPTT > 50 s). Ringer's lactate solution was used to maintain fluid volume during the operation at a rate of 5 ml/kg/h. When the hemodynamic target was not attained despite adequate intravascular volume replacement, we considered circulatory support with vasopressors. In the present study, the maximum allowable dose of HES was 20 ml/kg to prevent the adverse effects of HES solution.

Bottom Line: The percentage change in the FIBTEM maximum clot firmness was greatest in Group-PEN (P = 0.011).The international normalized ratio of prothrombin time (P < 0.001) and the activated partial thromboplastin time (P < 0.001) were significantly prolonged in Group-PEN compared to those of Group-TETB.No differences in hemostatic profile were observed between the balanced electrolyte and saline-based 6% HES 130/0.4.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

ABSTRACT

Background: Hydroxyethyl starch (HES) solutions are used as plasma expanders for correcting hypovolemia, but can lead to impaired coagulation. We evaluated the changes in hematological and hemostatic profiles with three types of HES.

Methods: Patients were randomized to receive volume replacement with 10% pentastarch 260/0.45 in 0.9% saline (Group-PEN, n = 25), 6% tetrastarch 130/0.4 in 0.9% saline (Group-TETS, n = 25), or 6% tetrastarch 130/0.4 in a balanced electrolyte solution (Group-TETB, n = 25). Coagulation was assessed using rotational thromboelastometry (ROTEM®) and other laboratory tests were performed, including measurements of hematological and hemostatic parameters and electrolytes.

Results: Post-operative ROTEM® parameters changed toward hypocoagulable states in all groups. The post-operative parameters of EXTEM and FIBTEM were more impaired in Group-PEN than in Group-TETB. The percentage change in INTEM clot formation time (P = 0.004) and α-angle (P = 0.003) were smaller in Group-TETS and Group-TETB than in Group-PEN. The percentage change in the FIBTEM maximum clot firmness was greatest in Group-PEN (P = 0.011). The international normalized ratio of prothrombin time (P < 0.001) and the activated partial thromboplastin time (P < 0.001) were significantly prolonged in Group-PEN compared to those of Group-TETB.

Conclusions: The 6% HES 130/0.4 in a balanced electrolyte solution seemed to have less of an impact on blood coagulation than the 10% HES 260/0.45. No differences in hemostatic profile were observed between the balanced electrolyte and saline-based 6% HES 130/0.4.

No MeSH data available.