NO COAGULATION DISORDERS UNDER HIGH-DOSE VOLUME THERAPY WITH LOW-MOLECULAR-WEIGHT HYDROXYETHYL STARCH

Hydroxyethyl starch (HES) is often used for volume therapy. Since blee ding complications have been reported repeatedly, a strict dose limita tion of a maximum of 1,500 mi 6% solution per day is recommended. Howe ver, many indications require higher dosages. Bleeding complications a re known to be caused by an acquired von Willebrand syndrome. It has b een shown that the accumulation of large molecules and their impairmen t in the coagulation system can be avoided by using HES preparations w ith a low in vivo molecular weight. However, the effects of a high-dos e therapy have not been studied yet. We have investigated, how a 4-day high-dose therapy, using 3,000 mi 6% HES 70/0.5 on the ist day and 1, 500 mi on days 2-4, affects the coagulation system and hemorheological parameters of acute stroke patients. Thromboplastin time, activated p artial thromboplastin time and thrombin time showed no significant cha nges, except for a slight, clinically irrelevant change due to dilutio n. The subunits of von Willebrand factor VIII showed no significant ch ange. Hematocrit decreased from 42.3 +/- 4.6 to 37.4 +/- 3.9% (p < 0.0 5) after day 1, reaching 35.3 +/- 4.2% (p < 0.01) at the end of the th erapy, demonstrating a substantial volume effect. Plasmaviscosity and erythrocyte aggregation decreased slightly, however not significantly. Our study shows that even a high-dose therapy with 6% HES 70/0.5 has no influence on the coagulation system.