Changes in blood coagulation after colloid administration in patients undergoing total hip arthroplasty: comparison between pentastarch and tetrastarches, a randomized trial.
10.4097/kjae.2015.68.4.364
- Author:
Hyun Jung SHIN
1
;
Hyo Seok NA
;
Young Tae JEON
;
Gwan Woo LEE
;
Sang Hwan DO
Author Information
1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. shdo@snu.ac.kr
- Publication Type:Randomized Controlled Trial ; Original Article
- Keywords:
Blood coagulation;
Hydroxyethyl starch;
Rotational thromboelastometry
- MeSH:
Arthroplasty, Replacement, Hip*;
Blood Coagulation*;
Colloids*;
Electrolytes;
Humans;
Hydroxyethyl Starch Derivatives*;
Hypovolemia;
International Normalized Ratio;
Partial Thromboplastin Time;
Plasma;
Prothrombin Time;
Starch;
Thrombelastography
- From:Korean Journal of Anesthesiology
2015;68(4):364-372
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Hydroxyethyl starch (HES) solutions are used as plasma expanders for correcting hypovolemia, but can lead to impaired coagulation. We evaluated the changes in hematological and hemostatic profiles with three types of HES. METHODS: Patients were randomized to receive volume replacement with 10% pentastarch 260/0.45 in 0.9% saline (Group-PEN, n = 25), 6% tetrastarch 130/0.4 in 0.9% saline (Group-TET(S), n = 25), or 6% tetrastarch 130/0.4 in a balanced electrolyte solution (Group-TET(B), n = 25). Coagulation was assessed using rotational thromboelastometry (ROTEM(R)) and other laboratory tests were performed, including measurements of hematological and hemostatic parameters and electrolytes. RESULTS: Post-operative ROTEM(R) parameters changed toward hypocoagulable states in all groups. The post-operative parameters of EXTEM and FIBTEM were more impaired in Group-PEN than in Group-TET(B). The percentage change in INTEM clot formation time (P = 0.004) and alpha-angle (P = 0.003) were smaller in Group-TET(S) and Group-TET(B) than in Group-PEN. The percentage change in the FIBTEM maximum clot firmness was greatest in Group-PEN (P = 0.011). The international normalized ratio of prothrombin time (P < 0.001) and the activated partial thromboplastin time (P < 0.001) were significantly prolonged in Group-PEN compared to those of Group-TET(B). CONCLUSIONS: The 6% HES 130/0.4 in a balanced electrolyte solution seemed to have less of an impact on blood coagulation than the 10% HES 260/0.45. No differences in hemostatic profile were observed between the balanced electrolyte and saline-based 6% HES 130/0.4.
