A Comparative Coagulopathic Study for Treatment of Vasospasm by Using Low- and High-molecular Weight Hydroxyethyl Starches.
10.3340/jkns.2007.42.5.377
- Author:
Sung Ho HWANG
1
;
Yu Sam WON
;
Jang Sun YU
;
Jae Young YANG
;
Chun Sik CHOI
Author Information
1. Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. yusam.won@Samsung.com
- Publication Type:Original Article
- Keywords:
Coagulopathy;
Hydroxyethyl starch (HES);
Partial thromboplastin time (PTT);
Subarachnoid hemorrhage;
Vasospasm
- MeSH:
Blood Coagulation;
Fibrinogen;
Hemorrhage;
Humans;
Infusions, Intravenous;
Molecular Weight;
Partial Thromboplastin Time;
Platelet Count;
Prothrombin Time;
Retrospective Studies;
Starch*;
Subarachnoid Hemorrhage
- From:Journal of Korean Neurosurgical Society
2007;42(5):377-381
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than does low-molecular-weight HES. We compared the effects of low- and high-molecular-weight HES for the treatment of vasospasm and investigated the dose relationship with each other. METHODS: Retrospectively, in a series of consecutive 102 patients with subarachnoid hemorrhage (SAH), 35 patients developed clinical symptoms of vasospasm of these fourteen patients were treated with low-molecularweight HES for volume expansion while the other 21 received high-molecular-weight HES as continuous intravenous infusion. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen level, and platelet count were all measured prior to initiation, during treatment and after termination of therapy for symptomatic vasospasm. The total dose of HES ranged from 5 L to 14 L and median infusion duration was 10 days. RESULTS: A more pronounced PTT prolongation was observed in high-molecular-weight HES group compared with low-molecular-weight HES group. No other coagulation parameters were altered. Dosage (=duration) shows a positive correlation with PTT. Clinically, significant bleeding episodes were noted in four patients who received high-molecular-weight HES. CONCLUSION: Coagulopathy was developed in direct proportion to molecular weight of starch and dosages. We propose the extreme caution in the administration of HES solution for the vasospasm treatment.
