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      Comparison of the in vitro effects of saline, hypertonic hydroxyethyl starch, hypertonic saline, and two forms of hydroxyethyl starch on whole blood coagulation and platelet function in dogs : Effects of volume expanders on hemostasis

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          Hydroxyethyl starches: different products--different effects.

          With the development of a new generation of hydroxyethyl starches (HES), there has been renewed interest in their clinical potential. High doses of first- and second-generation HES were associated with adverse effects on renal function, coagulation, and tissue storage, thereby limiting their clinical applicability. Newer HES products have lower molar substitution and in vivo molecular weight, resulting in more rapid metabolism and clearance. In this review article, the differences between HES generations are highlighted, with particular emphasis on the improved safety profile of the third generation products. These improvements have been achieved with no loss of efficacy, and they contradict the assumption that efficacy of HES solutions is directly linked to plasma concentration. The impact of source material on structure and pharmacokinetics is highlighted, and the role of the carrier solution is critically assessed.
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            Effects of hydroxyethyl starch solutions on hemostasis.

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              The effects of hydroxyethyl starches of varying molecular weights on platelet function.

              We evaluated the effect of various hydroxyethyl starch (HES) solutions on platelet function. Blood was obtained before and after the IV infusion (10 mL/kg) of saline (n = 10), HES 70/0.5--0.55 (molecular weight in kD/degree of substitution; n = 10), HES 130/0.38--0.45 (n = 10), HES 200/0.6--0.66 (n = 10), or HES 450/0.7--0.8 (n = 10) in otherwise healthy patients scheduled for elective surgery. Collagen and epinephrine were used as agonists for assessment of platelet function analyzer closure times. Flow cytometry was used to assess agonist-induced expression of activated glycoprotein IIb/IIIa complex and P-selectin. Infusion of HES 450/0.7--0.8, HES 200/0.6--0.66, and HES 70/0.5--0.55 prolonged closure times and reduced glycoprotein IIb/IIIa expression, whereas saline and HES 130/0.38--0.45 had no significant effect on platelet variables. P selectin expression was not affected by any solution tested. In vitro experiments demonstrated a less inhibiting effect of HES 130/0.38--0.45 on closure times when compared with other HES solutions. This study shows that HES 450/0.7--0.8, HES 200/0.6--0.66, and HES 70/0.5--0.55 inhibit platelet function by reducing the availability of the functional receptor for fibrinogen on the platelet surface. Our data indicate that fluid resuscitation with HES 130/0.38--0.45 may reduce the risk of bleeding associated with synthetic colloids of higher molecular weight and degree of substitution.
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                Author and article information

                Journal
                Journal of Veterinary Emergency and Critical Care
                Journal of Veterinary Emergency and Critical Care
                Wiley
                14793261
                July 2015
                July 2015
                June 02 2015
                : 25
                : 4
                : 474-487
                Affiliations
                [1 ]Division of Small Animal Emergency and Critical Care; Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern; Bern Switzerland
                [2 ]the Diagnostic Laboratory; Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern; Bern Switzerland
                [3 ]Small Animal Internal Medicine; Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern; Bern Switzerland
                Article
                10.1111/vec.12320
                26037241
                13e5edee-f596-4d9a-80f6-cc0067fd1101
                © 2015

                http://doi.wiley.com/10.1002/tdm_license_1.1

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