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Anesth Analg 2001;92:855-862
© 2001 International Anesthesia Research Society

CARDIOVASCULAR ANESTHESIA

Voluven®, a Lower Substituted Novel Hydroxyethyl Starch (HES 130/0.4), Causes Fewer Effects on Coagulation in Major Orthopedic Surgery than HES 200/0.5

Olivier Langeron, MD*, Martin Doelberg, PhD{dagger}, Eng-Than Ang, MD{ddagger}, Francis Bonnet, MD§, Xavier Capdevila, MD, PhD||, and Pierre Coriat, MD*

*Département d’Anesthésie-Réanimation, Centre Hospitalo-universitaire (CHU) Pitié-Salpêtrière, Paris, France; {dagger}Fresenius Kabi, Fluid Therapy Division, Bad Homburg, Germany; {ddagger}Département d’Anesthésie-Réanimation, Centre Hospitalo-universitaire (CHU) Beaujon, Clichy, France; §Département d’Anesthésie-Réanimation, Centre Hospitalo-universitaire (CHU) Tenon, Paris, France; ||Département d’Anesthésie-Réanimation, Centre Hospitalo-universitaire (CHU) Lapeyronie, Montpellier, France

Address correspondence and reprint requests to O. Langeron, MD, Département d’Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75651 Paris Cédex 13, France. Address e-mail to olivier.langeron{at}psl.ap-hop-paris.fr

Hydroxyethyl starch (HES) solutions are effective plasma volume expanders. Impairment of coagulation occurs with large HES volumes infused perioperatively. Therefore, a lower substituted novel HES (Voluven®; Fresenius Kabi, Bad Homburg, Germany) was developed to minimize hemostatic interactions, and was compared with HAES-steril® (Fresenius Kabi) (pentastarch) regarding safety and efficacy. We performed a prospective, randomized, double-blinded study in 100 major orthopedic surgery patients. Because the 95% confidence interval (-330 mL; +284 mL) for the treatment contrast Voluven®-HAES-steril® was entirely included in the predefined equivalence range (± 500 mL), comparable efficacy was established. Voluven® interfered significantly less than HAES-steril® with coagulation factor VIII levels and partial thromboplastin time postoperatively. Total amounts of red blood cells transfused were comparable between the Voluven® and HAES-steril® groups, but a significantly reduced need for homologous red blood cells was observed in the Voluven® group. We conclude that in large-blood–loss surgery, Voluven® has a comparable efficacy with HAES-steril® and may reduce coagulation impairment, possibly leading to a smaller number of allogeneic blood transfusions.

Implications: Hydroxyethyl starches are common plasma volume expanders, but may interfere with coagulation at large doses. We tested a novel hydroxyethyl starch specification (Voluven®; Fresenius Kabi, Bad Homburg, Germany) which was developed to reduce hemostatic interactions while preserving its efficacy in restoring plasma volume in comparison to HAES-steril® (pentastarch; Fresenius Kabi) in major orthopedic surgery.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2001 by the International Anesthesia Research Society.