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Annals of Surgery:
doi: 10.1097/SLA.0000000000000267
Randomized Controlled Trials

Hydroxyethyl Starch Reduces Coagulation Competence and Increases Blood Loss During Major Surgery: Results From a Randomized Controlled Trial

Rasmussen, Kirsten C. MD*; Johansson, Pär I. MD, DMSc, MPA; Højskov, Michael MD*; Kridina, Irina MD*; Kistorp, Thomas MD*; Thind, Peter MD, DMSc; Nielsen, Henning B. MD, DMSc*; Ruhnau, Birgitte MD*; Pedersen, Tom MD, DMSc§; Secher, Niels H. MD, DMSc*

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Abstract

Objective: This study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss.

Background: Artificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius Kabi, Uppsala, Sweden) only a minor effect on coagulation competence is expected.

Methods: Eighty patients were scanned for enrolment in the study, and 40 patients fulfilled the inclusion criteria. Two patients withdrew their consent to participate in the study, and 5 patients were excluded. Thus, 16 patients were randomized to receive lactated Ringer's solution and 17 to receive HES 130/0.4.

Results: Among the patients receiving HES 130/0.4, thrombelastography indicated reduced clot strength (P < 0.001) and blinded evaluation of the perioperative blood loss was 2.2 (range 0.5 to 5.0) versus 1.4 (range 0.5 to 2.4) L in the patients who received HES 130/0.4 or lactated Ringer, respectively (P < 0.038). The patients in the lactated Ringer's group, however, received more fluid (P < 0.0001) than those in the HES 130/0.4 group. There was no significant difference between the 2 groups with regard to frequency of reoperations or the length of hospital stay, but use of HES 130/0.4 was both more expensive and less efficacious than the use of lactated Ringer.

Conclusions: Administration of HES 130/0.4 reduced clot strength and perioperative hemorrhage increased by more than 50%, while administration of lactated Ringer's solution provoked an approximately 2.5 times greater positive volume balance at the end of surgery.

© 2014 by Lippincott Williams & Wilkins.

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