COMPROMISED BLOOD-COAGULATION - AN IN-VITRO COMPARISON OF HYDROXYETHYL STARCH 130 0.4 AND HYDROXYETHYL STARCH 200/0.5 USING THROMBOELASTOGRAPHY/

We compared the effects of progressive in vitro hemodilution (30% and 60%) on blood coagulation in 80 patients receiving one of two differen t 6% hydroxyethyl starch (HES) solutions using thrombelastography (TEG ). The newly developed solution has a mean molecular weight of 130 kD and a degree of substitution, defined as the average number of hydroxy ethyl groups per glucose moiety, of 0.4 (HES 130/0.4); the conventiona l solution has a mean molecular weight of 200 kD and a degree of subst itution of 0.5 (HES 200/0.5). Both HES solutions significantly comprom ised blood coagulation, as seen by an increase in reaction time and co agulation time and a decrease in angle alpha, maximal amplitude, and c oagulation index (all P < 0.05). There was no difference between HES 1 30/0.4 and HES 200/0.5 diluted blood (P > 0.05 for all TEG variables). When analyzing the intrinsic HES effect by taking hemodilution with 0 .9% saline into account, progressive hemodilution with both HES soluti ons resulted in an increasing clot lysis (P < 0.05 after 60 min). Agai n, there was no difference between HES 130/0.4 and HES 200/0.5 diluted blood. We conclude that HES 130/0.4 and HES 200/0.5 compromise blood coagulation to the same degree. Implications: Progressive in vitro hem odilution using hydroxyethyl starch (HES) compromises blood coagulatio n. We observed similar effects of a new HES solution with a mean molec ular weight of 130 kD and a degree of substitution of 0.4 (HES 130/0.4 ), compared with the conventional HES 200/0.5.