• R Scherer, R Giebler, S Kampe, and W J Kox.
• Institut für Anästhesiologie, Universitätsklinikum, GHS Essen, FRG.
• Infusionsther Transfusionsmed. 1994 Oct 1;21(5):310-4.

ObjectiveThe purpose of this study was to investigate the effect of hypertonic (NaCl 7.5%) hydroxyethyl starch (HES 6%, molecular weight 200,000) (HHES) as used for small-volume resuscitation on global coagulation parameters and platelet function.DesignRandomized, controlled clinical trial.SettingIntraoperative volume loading after induction of general anesthesia.Patients27 consecutive patients [mean age 59 (22-76) years, mean body weight 69.8 (46-98) kg] undergoing abdominal surgery were studied.InterventionsGlobal coagulation tests (aPTT: activated partial thromboplastin time; PT: prothrombin time; platelet count; thrombelastography: TEG), platelet aggregation and ATP release were measured before and 10 min after the application of 4 ml.kg-1 of HHES (study group H, n = 14) or HES (control group C, n = 13).ResultsThe aPTT was prolonged and platelet count was significantly reduced in both study groups. In contrast to the HES group, clot formation time in the TEG was significantly prolonged and the maximum amplitude was reduced in the HHES group. Furthermore, platelet aggregation was significantly slowed down, whereas ATP release significantly increased in the HHES group.ConclusionThe changes in global coagulation parameters can be explained by dilutional effects of the infused solution. The hyperosmolar saline compound of the HHES solution obviously contributes to the slowing down of platelet aggregation. Osmotic stress and membrane pleating may aggravate HES-induced changes in membrane fluidity and microviscosity and thus explain this impaired interaction. The increase in ATP release suggests a change in receptor-second messenger interaction for delta granule release.

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