Hydroxyethyl Starch Reduces Coagulation Competence and Increases Blood Loss During Major Surgery: Results From a Randomized Controlled Trial

TY - JOUR

T1 - Hydroxyethyl Starch Reduces Coagulation Competence and Increases Blood Loss During Major Surgery

T2 - Results From a Randomized Controlled Trial

AU - Rasmussen, Kirsten C

AU - Johansson, Pär I

AU - Højskov, Michael

AU - Kridina, Irina

AU - Kistorp, Thomas

AU - Thind, Peter

AU - Nielsen, Henning B

AU - Ruhnau, Birgitte

AU - Pedersen, Tom

AU - Secher, Niels H

PY - 2014/2

Y1 - 2014/2

N2 - OBJECTIVE:: This study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss. BACKGROUND:: Artificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius Kabi, Uppsala, Sweden) only a minor effect on coagulation competence is expected. METHODS:: Eighty patients were scanned for enrolment in the study, and 40 patients fulfilled the inclusion criteria. Two patients withdrew their consent to participate in the study, and 5 patients were excluded. Thus, 16 patients were randomized to receive lactated Ringer's solution and 17 to receive HES 130/0.4. RESULTS:: Among the patients receiving HES 130/0.4, thrombelastography indicated reduced clot strength (P < 0.001) and blinded evaluation of the perioperative blood loss was 2.2 (range 0.5 to 5.0) versus 1.4 (range 0.5 to 2.4) L in the patients who received HES 130/0.4 or lactated Ringer, respectively (P < 0.038). The patients in the lactated Ringer's group, however, received more fluid (P < 0.0001) than those in the HES 130/0.4 group. There was no significant difference between the 2 groups with regard to frequency of reoperations or the length of hospital stay, but use of HES 130/0.4 was both more expensive and less efficacious than the use of lactated Ringer. CONCLUSIONS:: Administration of HES 130/0.4 reduced clot strength and perioperative hemorrhage increased by more than 50%, while administration of lactated Ringer's solution provoked an approximately 2.5 times greater positive volume balance at the end of surgery.

AB - OBJECTIVE:: This study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss. BACKGROUND:: Artificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius Kabi, Uppsala, Sweden) only a minor effect on coagulation competence is expected. METHODS:: Eighty patients were scanned for enrolment in the study, and 40 patients fulfilled the inclusion criteria. Two patients withdrew their consent to participate in the study, and 5 patients were excluded. Thus, 16 patients were randomized to receive lactated Ringer's solution and 17 to receive HES 130/0.4. RESULTS:: Among the patients receiving HES 130/0.4, thrombelastography indicated reduced clot strength (P < 0.001) and blinded evaluation of the perioperative blood loss was 2.2 (range 0.5 to 5.0) versus 1.4 (range 0.5 to 2.4) L in the patients who received HES 130/0.4 or lactated Ringer, respectively (P < 0.038). The patients in the lactated Ringer's group, however, received more fluid (P < 0.0001) than those in the HES 130/0.4 group. There was no significant difference between the 2 groups with regard to frequency of reoperations or the length of hospital stay, but use of HES 130/0.4 was both more expensive and less efficacious than the use of lactated Ringer. CONCLUSIONS:: Administration of HES 130/0.4 reduced clot strength and perioperative hemorrhage increased by more than 50%, while administration of lactated Ringer's solution provoked an approximately 2.5 times greater positive volume balance at the end of surgery.

KW - Aged

KW - Blood Coagulation

KW - Blood Coagulation Tests

KW - Blood Loss, Surgical

KW - Cost-Benefit Analysis

KW - Cystectomy

KW - Denmark

KW - Double-Blind Method

KW - Female

KW - Hospital Costs

KW - Humans

KW - Hydroxyethyl Starch Derivatives

KW - Hypovolemia

KW - Intraoperative Complications

KW - Isotonic Solutions

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Plasma Substitutes

KW - Postoperative Complications

KW - Prospective Studies

KW - Treatment Outcome

U2 - 10.1097/SLA.0000000000000267

DO - 10.1097/SLA.0000000000000267

M3 - Journal article

C2 - 24100337

SN - 0003-4932

VL - 259

SP - 249

EP - 254

JO - Annals of Surgery

JF - Annals of Surgery

IS - 2

ER -