Article

Effects of different plasma substitutes on blood coagulation: a comparative review.

Department of Intensive Care, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands.
Critical Care Medicine (Impact Factor: 6.15). 07/2001; 29(6):1261-7. DOI: 10.1097/00003246-200106000-00038
Source: PubMed

ABSTRACT To compare the effects of different colloid plasma substitutes on blood coagulation and postoperative blood loss.
Relevant studies were obtained from the medical literature.
Articles were selected that provided data on the effects of colloids on hemostasis and postoperative blood loss in humans. Studies comparing different colloids were looked for using MEDLINE and by searching through the references of studies as they were collected.
Articles were reviewed and relevant data were extracted and partly presented in comparative tables.
Dextran, gelatin, and hydroxyethyl starch (HES) all can induce a specific decrease of von Willebrand factor and factor VIII:c. Blood coagulation is most impaired by dextran and high molecular weight HES, both associated with increased postoperative blood loss. The effects of HES on blood coagulation have been shown to depend on its molecular weight and rate of elimination. Detrimental effects have been shown for high molecular weight HES. Medium molecular weight (MMW)-HES with a high degree of substitution (HES 200/0.62) and MMW-HES with high C2/C6 hydroxyethylation ratio (HES 200/0.5/13) are slowly degradable and have been shown to impair blood coagulation after repeated administration. Rapidly degradable HES 200/0.5/6 and gelatin-based plasma expanders appear not to impair hemostasis. However, based on the reviewed literature, all artificial colloids could potentially induce increased bleeding tendency after infusion of very large volumes and especially when given to patients with even mild forms of von Willebrand disease. In those circumstances, crystalloid solutions or alternatives such as plasma or albumin, although associated with other serious complications, could be considered.

0 Bookmarks
 · 
98 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Proper fluid management is crucial for the management of critically ill patients. However, there is a continuing debate about the choice of the fluid, i.e., crystalloid vs. colloid. Colloid solution is theoretically advantageous to the crystalloid because of larger volume effect and less interstitial fluid accumulation, and hydroxyethyl starch (HES) is most frequently used for perioperative setting. Nevertheless, application of HES solution is relatively limited due to its side effects including renal toxicity and coagulopathy. Since prolonged presence of large HES molecule is responsible for these side effects, rapidly degradable HES solution with low degree of substitution (tetrastarch) supposedly has less potential for negative effects. Thus, tetrastarch may be more frequently used in the ICU setting. However, several large-scale randomized trials reported that administration of tetrastarch solution to the patients with severe sepsis has negative effects on mortality and renal function. These results triggered further debate and regulatory responses around the world. This narrative review intended to describe the currently available evidence about the advantages and disadvantages of tetrastarch in the ICU setting.
    Journal of intensive care. 01/2014; 2(1):23.
  • Journal of the Korean Medical Association 01/2010; 53(12):1103. · 0.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Haemorrhage remains a major cause of potentially preventable deaths. Rapid transfusion of large volumes of blood products is required in patients with haemorrhagic shock which may lead to a unique set of complications. Recently, protocol based management of these patients using massive transfusion protocol have shown improved outcomes. This section discusses in detail both management and complications of massive blood transfusion.
    Indian journal of anaesthesia 09/2014; 58(5):590-5.

Full-text (2 Sources)

Download
273 Downloads
Available from
May 31, 2014