01 Jan 10
HES130/0.4 impairs haemostasis and stimulates pro-inflammatory blood platelet function
By M Sossdorf, S Marx, B Schaarschmidt, G Otto, R Claus, K Reinhart, C Hartog and W Loesche
Hydroxyethyl starch (HES) solutions are widely used for volume replacement therapy but are also known to compromise coagulation, impair renal function and increase long-term mortality. To test the hypotheses that HES 130/0.4 has less adverse effects than HES 200/0.5 and exerts anti-inflammatory properties we compared the effects of HES130/0.4, HES200/0.5 and saline on in vitro haemostasis and pro-inflammatory platelet function.
Methods
Whole blood samples from healthy volunteers were mixed with 6% HES130/0.4, 10% HES200/0.5, or normal saline to achieve a final haemodilution rate of 10 % or 40 %. Haemostatic capacity was characterised by thromboelastography (ROTEM) and measurement for FXIIIa activity. Platelet activation and pro-inflammatory platelet functions were characterised by flow cytometry measuring the platelet activation marker CD62P and binding of fibrinogen to platelets as well as the formation of heterotypic platelet-leukocyte conjugates.
Results
Compared to saline, HES130/0.4 dose-dependently impaired formation and firmness of the fibrin clot but did not affect the fibrin-crosslinking activity of FXIIIa. At 40 % but not at 10 % haemodilution rate HES200/0.5 also increased platelet fibrinogen binding and both HES solutions increased expression of CD62P, the main receptor for platelet-leukocyte adhesion. HES130/0.4 but not HES200/0.5 increased formation of platelet-neutrophil conjugates and, to a lesser degree, platelet-monocyte conjugates.
HES130/0.4 impairs haemostasis and stimulates pro-inflammatory blood platelet function
Conclusions
Our data demonstrate that HES130/0.4 has similar adverse effects as HES200/0.5. In particular, both types of HES impair coagulation capacity and stimulate rather than attenuate pro-inflammatory platelet function.