Activity of blood coagulation and fibrinolysis during and after hydroxyethyl starch (HES) colloidal volume replacement

Objectives: To examine the effect of medium molecular weight hydroxyethyl s tarch on protein C levels and the changes in the activation state of blood platelets, coagulation and fibrinolyis during and after 5 day of its infusi on. Design and Methods: Fifty male patients (mean age: 47 years, range 45-50 ye ars) who required prostatectomy for benign prostatic hyperplasia were divid ed into two equal groups. One group was given 15 mL/kg body weight (mean vo lume 1000 mL +/- 100 mL) of 6% hydroxyethyl starch (HES) 200/0.5, the other received an equal volume of 5% human albumin during the operation. Blood s amples were collected immediately before infusion (baseline values) and at 20, 40, 60, 90, 240, and 480 min after the infusion started then daily for the next 5 days postoperatively. Hematocrit, factor VIII:C, thrombin-antith rombin III complex; the anticoagulant protein C levels; the fibrinolytic pa rameters tissue type plasminogen activator (t-PA), and the fibrinolytic pro duct D-Dimer and the platelet aggregation activity were measured, Results: The data obtained did not detect any significant differences betwe en HES and human albumin in the plasma levels of thrombin-antithrombin ill complex, protein C, tissue-type plasminogen activator and the fibrin split products D-Dimer. Factor VIII:C and platelet aggregation were significantly lower in the hydroxyethyl starch group in comparison with albumin. Baselin e values were attained postoperatively for factor VIII:C and platelet aggre gation by the first and fifth days, respectively. Conclusion: The lowering effect of medium molecular weight hydroxyethyl sta rch on factor VIII:C would not be attributed to increased proteolytic activ ity of protein C on this coagulation cofactor because there is a nonsignifi cant change in protein C levels. Copyright (C) 1999 The Canadian Society of Clinical Chemists.