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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.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.

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.


CONSORT diagram.
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Figure 2: CONSORT diagram.

Mentions: A total of 87 patients were evaluated for eligibility, of which 81 were each assigned to one of the three groups. Six of the randomized patients were excluded from the analysis (Fig. 2). Three patients (one patient from each group) were excluded as a result of conversion to general anesthesia because of a prolonged operation time due to unexpected surgical difficulty. Three patients (one patient from each group) required FFP transfusions during the operation at the surgeon's discretion (observed blood oozing in the operative field). Characteristics of the patients, surgery, and anesthesia were not significantly different among the three groups (Table 1). The volumes of colloid (P = 0.524) and crystalloid solutions (P = 0.250) infused during the operation were not significantly different among the groups (Table 1). There were no protocol violations during the operation.


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)

CONSORT diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: CONSORT diagram.
Mentions: A total of 87 patients were evaluated for eligibility, of which 81 were each assigned to one of the three groups. Six of the randomized patients were excluded from the analysis (Fig. 2). Three patients (one patient from each group) were excluded as a result of conversion to general anesthesia because of a prolonged operation time due to unexpected surgical difficulty. Three patients (one patient from each group) required FFP transfusions during the operation at the surgeon's discretion (observed blood oozing in the operative field). Characteristics of the patients, surgery, and anesthesia were not significantly different among the three groups (Table 1). The volumes of colloid (P = 0.524) and crystalloid solutions (P = 0.250) infused during the operation were not significantly different among the groups (Table 1). There were no protocol violations during the operation.

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.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.

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.