Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 2 , Pages 225-236 , June 2009

Influence of fluid therapy on the haemostatic system of intensive care patients

  • Sibylle A. Kozek-Langenecker, MD (Professor)

      Affiliations

    • Department of Anaesthesiology, General Intensive Care und Pain Management, Vienna Medical University, Währinger Gürtel 18-20, 1090 Vienna, Austria
    • Department of Anaesthesia and Intensive Care, Evangelisches Krankenhaus Wien, Hans Sachs-Gasse 10-12, 1180 Vienna, Austria
    • Corresponding Author InformationDepartment of Anaesthesiology, General Intensive Care und Pain Management, Vienna Medical University, Währinger Gürtel 18-20, 1090 Vienna, Austria. Tel.: +43 1 40400 4144; Fax: +43 1 40400 4165.

References 

  1. Kozek-Langenecker S. Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology. 2005;103:654–660
  2. Kozek-Langenecker S, Scharbert G. Effect of hydroxyethyl starches on hemostasis. Transfusion Alternatives in Transfusion Medicine. 2007;9:173–181
  3. Van der Linden P, Ickx B. The effects of colloid solutions on hemostasis. Canadian Journal of Anaesthesia. 2006;53:S30–S39
  4. Stögermüller B, Stark J, Willschke H, et al. The effects of hydroxyethyl starch 200 kD on platelet function. Anesthesia and Analgesia. 2000;91:823–827
  5. Franz A, Bräunlich P, Gamsjäger T, et al. The effects of hydroxyethyl starches of varying molecular weight on platelet function. Anesthesia and Analgesia. 2001;92:1402–1407
  6. Huttner I, Boldt J, Haisch G, et al. Influence of different colloids on molecular markers of haemostasis and platelet function in patients undergoing major abdominal surgery. British Journal of Anaesthesia. 2000;85:417–423
  7. Omar M, Shouk T, Khaleq M. Activity of blood coagulation and fibrinolysis during and after hydroxyethyl starch (HES) colloidal volume replacement. Clinical Biochemistry. 1999;32:269–274
  8. Gamsjäger T, Gustorff B, Kozek-Langenecker S. The effects of hydroxyethyl starches on intracellular calcium in platelets. Anesthesia and Analgesia. 2002;95:866–869
  9. Deusch E, Gamsjäger T, Kress H, et al. Binding of hydroxyethyl starch molecules to the platelet surface. Anesthesia and Analgesia. 2003;97:680–683
  10. deJonge E, Levi M. Effects of different plasma substitutes on blood coagulation: a comparative review. Critical Care Medicine. 2001;29:1261–1267
  11. Thaler U, Deusch E, Kozek-Langenecker S. In vitro effects of various gelatin solutions on platelet function and their comparison to hydroxyethyl starch solutions. Anaesthesia. 2005;60:554–559
  12. deJonge E, Levi M, Berends F, et al. Impaired haemostasis by intravenous administration of a gelatin-based plasma expander in human subjects. Thrombosis and Haemostasis. 1998;79:286–290
  13. Kheirabadi B, Crissey J, Deguzman R, et al. Effects of synthetic versus natural colloid resuscitation on inducing dilutional coagulopathy and increasing hemorrhage in rabbits. The Journal of Trauma. 2008;64:1218–1228
  14. Battle J, F Dr, Lopez Fernandez M, et al. Effect of dextran on factor VIII/von Willebrand factor structure and function. Thrombosis and Haemostasis. 1985;54:697–699
  15. Mittermayr M, Streif W, Haas T, et al. Haemostatic changes after crystalloid or colloid fluid administration during orthopedic surgery: the role of fibrinogen administration. Anesthesia and Analgesia. 2007;105:905–917
  16. Petroianu G, Maleck W, Koetter K, et al. Effect of in vitro hemodilution with hydroxyethyl starch and dextran on the activity of plasma clotting factors. Critical Care Medicine. 2003;31:250–254
  17. Entholzer E, Mielke L, Calatzis A, et al. Coagulation effects of a recently developed hydroxyethyl starch (HES 130/0.4) compared to hydroxyethyl starches with higher molecular weight. Acta Anaesthesiologica Scandinavica. 2000;44:1116–1121
  18. Tobias M, Wambold D, Pilla M, et al. Differential effects of serial hemodilution with hydroxyethyl starch, albumin, and 0.9% saline on whole blood coagulation. Journal of Clinical Anesthesia. 1998;10:366–371
  19. Fries D, Innerhofer P, Klingler A, et al. The effects of the combined administration of colloids and lactated Ringer's solution on the coagulation system: an in vitro study using thrombelastograph coagulation analysis (ROTEG). Anesthesia and Analgesia. 2002;94:1280–1287
  20. Nielsen V. Effects of PentaLyte and Voluven hemodilution on plasma coagulation kinetics in the rabbit: role of thrombin-fibrinogen and factor XIII-fibrin polymer interactions. Acta Anaesthesiologica Scandinavica. 2005;49:1263–1271
  21. Strauss R, Pennell B, Stump D. A randomized controlled trial comparing the hemostatic effects of pentastarch versus hetastarch. Transfusion. 2002;42:27–36
  22. Boldt J, Haisch G, Suttner S, et al. Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation. British Journal of Anaesthesia. 2002;89:722–728
  23. Nielsen V. Hemodilution modulates the time of onset and rate of fibrinolysis in human and rabbit plasma. The Journal of Heart and Lung Transplantation. 2006;25:1344–1352
  24. Niemi T, Kuitunen A. Artificial colloids impair haemostasis. An in vitro study using thromboelastometry coagulation analysis. Acta Anaesthesiologica Scandinavica. 2005;49:373–378
  25. deJonge E, Levi M, Buller R, et al. Decreased circulating levels of von Willebrand factor after intravenous administration of a rapidly degradable hydroxyethyl starch (HES 200/0.5/6) in healthy human subjects. Intensive Care Medicine. 2001;27:1825–1829
  26. Jamnicki M, Bombeli T, Seifert B, et al. Low- and medium-molecular-weight hydroxyethyl starches: comparison of their effect on blood coagulation. Anesthesiology. 2000;93:1231–1237
  27. Kapiotis S, Quehenberger P, Eichler H, et al. Effect of hydroxyethyl starch on the activity of blood coagulation and fibrinolysis in healthy volunteers: comparison with albumin. Critical Care Medicine. 1994;22:606–612
  28. Conroy J, Fishman R, Reeves S, et al. The effects of desmopressin and 6% hydroxyethyl starch on factor VIII: C. Anesthesia and Analgesia. 1996;83:804–807
  29. Treib J, Haass A, Pindur G, et al. All medium starches are not the same: influence of the degree of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, hemorrheologic conditions, and coagulation. Transfusion. 1996;36:450–455
  30. Jungheinrich C, Sauermann W, Bepperling F, et al. Volume efficacy and reduced influence on measures of coagulation using hydroxyethyl starch 130/0.4 (6%) with an optimised in vivo molecular weight in orthopedic surgery: a randomised, double-blind study. Drugs in R&D. 2004;5:1–9
  31. Neff T, Doelberg M, Jungheinrich C, et al. Repetitive large-dose infusion of the novel hydroxyethyl starch 130/0.4 in patients with severe head injury. Anesthesia and Analgesia. 2003;96:1453–1459
  32. Kasper S, Meinert P, Kampe S, et al. Large-dose hydroxyethyl starch 130/0.4 does not increase blood loss and transfusion requirements in coronary artery bypass surgery compared with hydroxyethyl starch 200/0.5 at recommended doses. Anesthesiology. 2003;99:42–47
  33. Kuitunen A, Hynynen M, Vahtera E, et al. Hydroxyethyl starch as a priming solution for cardiopulmonary bypass impairs hemostasis after cardiac surgery. Anesthesia and Analgesia. 2004;98:291–297
  34. Gallandat-Huet R, Siemons A, Baus D, et al. A novel hydroxyethyl starch (Voluven) for effective perioperative plasma volume substitution in cardiac surgery. Canadian Journal of Anaesthesia. 2000;47:1207–1215
  35. Langeron O, Doelberg M, Ang E, et al. Voluven, a lower substituted novel hydroxyethyl starch (HES 130/0.4), causes fewer effects on coagulation in major orthopedic surgery than HES 200/0.5. Anesthesia and Analgesia. 2001;92:855–862
  36. Ellger B, Freyhoff J, van Aken H, et al. High-dose volume replacement using HES 130/0.4 during major surgery. Nederlands Tijdschrift Voor Gerontologie. 2006;19:63–68
  37. Ruttmann TG, James MF, Viljoen JF. Haemodilution induces a hypercoagulable state. British Journal of Anaesthesia. 1996;76:412–414
  38. McCammon A, Wright J, Figueroa M, et al. Hemodilution with albumin, but not hextend®, results in hypercoagulability as assessed by thrombelastography® in rabbits: role of heparin-dependent serpins and factor VIII complex. Anesthesia and Analgesia. 2002;95:844–850
  39. Li L, Xu X. Effect of acute progressive normovolemic hemodilution with lactated Ringer's, gelatin and hydroxyethyl starch on coagulation and survival rate in rabbits. Beijing Da Xue Xue Bao. 2008;40:292–300
  40. Kretschmer V, Daraktchiev A, Bade S, et al. Does hemodilution enhance coagulability?. Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS. 2004;39:751–756
  41. Innerhofer P, Fries D, Margreiter J, et al. The effects of perioperatively administered colloids and crystalloids on primary platelet-mediated hemostasis and clot formation. Anesthesia and Analgesia. 2002;95:858–865
  42. Jamnicki M, Zollinger A, Seifert B, et al. Compromised blood coagulation: an in vitro comparison of hydroxyethyl starch 130/0.4 and hydroxyethyl starch 200/0.5 using thrombelastography. Anesthesia and Analgesia. 1998;87:989–993
  43. von Roten I, Madjdpour C, Frascarolo P, et al. Molar substitution and C2/C6 ratio of hydroxyethyl starch: influence on blood coagulation. British Journal of Anaesthesia. 2006;96:455–463
  44. Madjdpour C, Dettori N, Frascarolo P, et al. Molecular weight of hydroxyethyl starch: is there an effect on blood coagulation and pharmacokinetics?. British Journal of Anaesthesia. 2005;94:569–576
  45. Thyes C, Madjdpour C, Frascarolo P, et al. Effect of high- and low-molecular-weight low-substituted hydroxyethyl starch on blood coagulation during acute normovolemic hemodilution in pigs. Anesthesiology. 2006;105:1228–1237
  46. Strauss R, Stump D, Henriksen R, et al. Effects of hydroxyethyl starch on fibrinogen, fibrin clot formation and fibrinolysis. Transfusion. 1985;25:230–234
  47. Fenger-Eriksen C, Heslop J, Anker-Moller E, et al. Thrombelastographic whole blood clot formation following ex vivo addition of plasma substitutes: improvements of the induced coagulopathy with fibrinogen concentrate. British Journal of Anaesthesia. 2005;94:324–329
  48. Nielsen V. Colloids decrease clot propagation and strength: role of factor XIII-fibrin polymer and thrombin-fibrinogen interactions. Acta Anaesthesiologica Scandinavica. 2005;49:1163–1171
  49. Nielsen V, Kirklin J. Hydroxyethyl starch enhances argatroban-mediated decrease in clot propagation and strength by diminishing thrombin-fibrinogen interactions. Blood Coagulation & Fibrinolysis. 2007;18:49–54
  50. Jones S, Whitten C, Despotis G, et al. The influence of crystalloid and colloid replacement solutions in acute normovolemic hemodilution: a preliminary survey of hemostatic markers. Anesthesia and Analgesia. 2003;96:363–368
  51. Konrad C, Markl T, Schuepfer G, et al. The effects of in vitro hemodilution with gelatin, hydroxyethyl starch, and lactated Ringer's solution on markers of coagulation: an analysis using Sonoclot™. Anesthesia and Analgesia. 1999;88:483–488
  52. Haas T, Preinreich A, Oswald E, et al. Effects of albumin 5% and artificial colloids on clot formation in small infants. Anaesthesia. 2008;62:1000–1007
  53. Ickx B, Van der Linden P. Interactions entre les solutes colloides et l'hemostase. Sang Thrombose Vaisseaux. 2002;14:408–416
  54. Mittermayr M, Streif W, Haas T, et al. Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo. British Journal of Anaesthesia. 2008;100:307–314
  55. Eriksson M, Saldeen T. Effect of dextran on plasma tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) during surgery. Acta Anaesthesiologica Scandinavica. 1995;39:163–166
  56. Mohri H. Acquired von Willebrand syndrome: features and management. American Journal of Hematology. 2006;81:616–623
  57. Sorensen B, Fenger-Eriksen C, Ingerslev J. Recombinant factor VIIa fails to correct coagulopathy induced by haemodilution with colloids. British Journal of Anaesthesia. 2005;94:862–863
  58. Fries D, Krismer A, Klingler A, et al. Effect of fibrinogen on reversal of dilutional coagulopathy: a porcine model. British Journal of Anaesthesia. 2005;95:172–177
  59. Haas T, Fries D, Velik-Salchner C, et al. The in vitro effects of fibrinogen concentrate, factor XIII and fresh frozen plasma on impaired clot formation after 60% dilution. Anesthesia and Analgesia. 2008;106:1360–1365
  60. Lehmann G, Marx G, Foerster H. Bioequivalence comparison between hydroxyethyl starch 130/0.42/6: 1 and hydroxyethyl starch 130/0.4/9: 1. Journal of Drugs in R&D. 2007;8:229–240
  61. Sander O, Reinhart K, Meier-Hellmann A. Equivalence of hydroxyethyl starch HES 130/0.4 and HES 200/0.5 for perioperative volume replacement in mayor gynaecological surgery. Acta Anaesthesiologica Scandinavica. 2003;47:1151–1158
  62. Waters J, Gottlieb A, Schoenwald P, et al. Normal saline versus lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysma repair: an outcome study. Anesthesia and Analgesia. 2001;93:817–822
  63. Stephens R, Mythen M. Optimizing intraoperative fluid therapy. Current Opinion in Anaesthesiology. 2003;16:385–392
  64. Wilkes N, Woolf R, Mutch M, et al. The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesthesia and Analgesia. 2001;93:811–816
  65. Base E, Standl T, Lassnig A, et al. Comparison of 6% HES 130/0.4 in a balanced electrolyte solution versus 6% HES 130/0.4 in saline solution in cardiac surgery. Critical Care. 2006;10:P176
  66. Engstrom M, Schott U, Romner B, et al. Acidosis impairs the coagulation: a thromboelastographic study. The Journal of Trauma. 2006;61:624–628
  67. Roche A, James M, E B-G, et al. A head-to-head comparison of the in vitro coagulation effects of saline-based and balanced electrolyte crystalloid and colloid intravenous fluids. Anesthesia and Analgesia. 2006;102:1274–1279
  68. Boldt J, Wolf M, Mengistu A. A new plasma-adapted hydroxyethylstarch preparation: in vitro coagulation studies using thrombelastography and whole blood aggregometry. Anesthesia and Analgesia. 2007;104:425–430
  69. Weeks D, Jahr J, Lim J, et al. Does hextend impair coagulation compared to 6% hetastarch? An ex vivo thrombelastography study. American Journal of Therapeutics. 2008;15:225–230
  70. Scharbert G, Kozek-Langenecker S. Limitations of in vitro models. Anesthesia and Analgesia. 2007;105:885
  71. Deusch E, Thaler U, Kozek-Langenecker S. The effects of high molecular weight hydroxyethyl starch solutions on platelets. Anesthesia and Analgesia. 2004;99:665–668
  72. Gan TJ, Bennett-Guerrero E, Phillips-Bute B, et al. Hextend, a physiologically balanced plasma expander for large volume use in major surgery: a randomized phase III clinical trial. Anesthesia and Analgesia. 1999;88:992–998
  73. Boldt J, Schöllhorn T, Münchbach J, et al. A total balanced volume replacement strategy using a new balanced hydroxyethyl starch preparation (6% HES 130/0.42) in patients undergoing major abdominal surgery. European Journal of Anaesthesiology. 2007;24:267–275
  74. Kulla M, Weidhase R, Lampl L. Hydroxyethylstärke 6% 130/0,42 in Ringerazetat als Komponente eines balancierten Volumenersatzes in der Abdominalchirurgie. Anästhesiologie und Intensivmedizin. 2008;49:7–18
  75. Wilkes M, Navickis R, Sibbald W. Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. Annals of Thoracic Surgery. 2001;72:527–537
  76. Haisch G, Boldt J, Krebs C, et al. The influence of intravascular volume therapy with a new hydroxyethyl starch preparation (6% HES 130/0.4) on coagulation in patients undergoing major abdominal surgery. Anesthesia and Analgesia. 2001;92:565–571
  77. Boldt J, Knothe C, Zickmann B, et al. Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass. Anesthesia and Analgesia. 1993;76:1185–1190
  78. Gandhi S, Weiskopf R, Jungheinrich C, et al. Volume replacement therapy during major orthopedic surgery using Voluven (hydroxyethyl starch 130/0.4) or hetastarch. Anesthesiology. 2007;106:1120–1127
  79. Kozek-Langenecker S, Jungheinrich C, Sauermann W, et al. Hydroxyethyl starch 130/0.4 (6%): effects on blood loss and use of blood products in major surgery – a pooled analysis of randomized clinical trials. Anesthesia and Analgesia 2008;107:382–390.
  80. Cheng D, Belisle S, Giffin M, et al. Colloids for perioperative plasma volume expansion: systematic review with meta-analysis of controlled trials. Transfusion Alternatives in Transfusion Medicine. 2007;9:3 (abstract)
  81. Haas T, Fries D, Holz C, et al. Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch solution. Anesthesia and Analgesia. 2008;106:1078–1086
  82. Standl T, Burmeister M, Schroeder F, et al. Hydroxyethyl starch (HES) 130/0.4 provides larger and faster increases in tissue oxygen tension in comparison with prehemodilution values than HES 70/0.5 or HES 200/0.5 in volunteers undergoing acute normovolemic hemodilution. Anesthesia and Analgesia. 2003;96:936–943
  83. Tabuchi N, de Haan J, Gallandat-Huet R, et al. Gelatin use impairs platelet adhesion during cardiac surgery. Thrombosis and Haemostasis. 1995;74:1447–1451
  84. Mahla E, Lang T, Vincenzi M, et al. Thrombelastography for monitoring prolonged hypercoagulability after major abdominal surgery. Anesthesia and Analgesia. 2001;92:572–577
  85. McCrath DJ, Cerboni E, Frumento RJ, et al. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction. Anesthesia and Analgesia. 2005;100:1576–1583
  86. Collins P, Macchiavello L, Lewis S, et al. Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls. British Journal of Haematology. 2006;135:220–227
  87. Wang L, Bastarache J, Ware L. The coagulation cascade in sepsis. Current Pharmaceutical Design. 2008;14:1860–1869
  88. Dieterich H, Weissmüller T, Rosenberger P, et al. Effect of hydroxyethyl starch on vascular leak syndrome and neutrophil accumulation during hypoxia. Critical Care Medicine. 2004;34:1775–1782
  89. Lang K, Suttner S, Boldt J, et al. Volume replacement with HES 130/0.4 may reduce the inflammatory response in patients undergoing major abdominal surgery. Canadian Journal of Anaesthesia. 2003;50:1009–1016
  90. Volta A, Alvis V, Campi M, et al. Influence of different strategies of volume replacement on the activity of matrix metalloproteinase: an in vitro and in vivo study. Anesthesiology. 2007;106:85–91
  91. Meyer P, Pernet P, Hejblum B, et al. Haemodilution induced by hydroxyethyl starches 130/0.4 is similar in septic and non-septic patients. Acta Anaesthesiologica Scandinavica. 2008;52:229–235
  92. Hardy JF, de Moerloose P, Samama CM. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Canadian Journal of Anaesthesia. 2006;53:S40–S58
  93. Kozek-Langenecker S. Management of massive operative blood loss. Minerva Anestesiologica. 2007;73:401–415
  94. Watters J, Tieu B, Differding J, et al. A single bolus of 3% hypertonic saline with 6% dextran provides optimal initial resuscitation after uncontrolled hemorrhagic shock. The Journal of Trauma. 2006;61:75–81
  95. Wiedermann I, Scharbert G, Schöchl H, et al. Hydroxyethyl starch in hypertonic saline and platelet function. Anesthesiology. 2007;107:A549
  96. Brummel-Ziedins K, Whelihan M, Ziedins E, et al. The resuscitation fluid you choose may potentiate bleeding. The Journal of Trauma. 2006;61:1350–1358
  97. Singh N, Singh S, Kaur L, et al. Morphological, thermal and rheological properties of starches from different botanical sources. Food Chemistry. 2003;81:219–231
  98. Kwan I, Bunn F, Robert F. Timing and volume of fluid administration for patients with bleeding. Cochrane Database of Systematic Reviews. 2003;3:CD002245
  99. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews. 2008;4:CD000567
  100. Kozek-Langenecker S, Scharbert G. Which hemostatic changes determine clinical outcome?. Anesthesia and Analgesia. 2008;106:1588

PII: S1521-6896(08)00099-2

doi: 10.1016/j.bpa.2008.11.002

Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 2 , Pages 225-236 , June 2009