Hemostatic changes in patients receiving hydroxyethyl starch: The influence of ABO blood group

Hydroxyethyl starches (HES) interfere with coagulation because of their mol ecular structure and the amount infused during surgery. Coagulation defects include platelet dysfunction and a decrease of the VIII/von Willebrand fac tor complex (VIII/vWF). We examined the effects of 6% HES 200/0.6 on hemost asis by using an in vitro platelet function analyzer, the usual coagulation tests, the VIII/vWF complex assessment, and TEG (R) analysis in patients u ndergoing abdominal surgery. The influence of the blood group was investiga ted. HES infusion induced primary hemostasis alterations, assessed by a pro longed platelet function analyzer closure time in the presence of epinephri ne and adenosine diphosphate, which was not correlated with the platelet co unt. The decrease in VIII/vWF complex was proportional to the volume of inf used HES (20 and 30 mL/kg) and was more pronounced in patients of the O blo od group. The preoperative hypercoagulability status assessed by TEG (R) an alysis was reversed 24 h after HES infusion. In conclusion, 6% HES 200/0.6 induced immediate hemostasis alterations. Patients of the O blood group wer e likely to develop a von Willebrand-like syndrome after HES infusion. We c onclude that intraoperative use of 6% HES 200/0.6 should be restricted in p atients of the O blood group undergoing surgical procedures with high risk for bleeding.