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CARDIOVASCULAR ANESTHESIA

Hemostatic Changes in Patients Receiving Hydroxyethyl Starch: The Influence of ABO Blood Group

Catherine Huraux, MD^*, Annick Ankri A, MD, Daniel Eyraud, MD^*, Odile Sevin, Fabrice Ménégaux, MD, Pierre Coriat, MD^*, and Charles-Marc Samama, MD, PhD^*

*Department of Anesthesiology; Laboratory of Hematology; and Department of General Surgery, Hôpital Pitié-Salpêtrière, Paris, France; and Department of Anesthesiology, Hôpital Avicennes, Bobigny, France

Address correspondence and reprint requests to Catherine Huraux, Département d’Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, 47, Boulevard de l’Hôpital, 75651 Paris, Cedex 13, France. Address e-mail to catherine.huraux{at}psl.ap-hop-paris.fr

Hydroxyethyl starches (HES) interfere with coagulation because of their molecular structure and the amount infused during surgery. Coagulation defects include platelet dysfunction and a decrease of the VIII/von Willebrand factor complex (VIII/vWF). We examined the effects of 6% HES 200/0.6 on hemostasis by using an in vitro platelet function analyzer, the usual coagulation tests, the VIII/vWF complex assessment, and TEG® analysis in patients undergoing abdominal surgery. The influence of the blood group was investigated. HES infusion induced primary hemostasis alterations, assessed by a prolonged platelet function analyzer closure time in the presence of epinephrine and adenosine diphosphate, which was not correlated with the platelet count. The decrease in VIII/vWF complex was proportional to the volume of infused HES (20 and 30 mL/kg) and was more pronounced in patients of the O blood group. The preoperative hypercoagulability status assessed by TEG® analysis was reversed 24 h after HES infusion. In conclusion, 6% HES 200/0.6 induced immediate hemostasis alterations. Patients of the O blood group were likely to develop a von Willebrand-like syndrome after HES infusion. We conclude that intraoperative use of 6% HES 200/0.6 should be restricted in patients of the O blood group undergoing surgical procedures with high risk for bleeding.

Implications: A von Willebrand-like syndrome occurred immediately after 6% HES 200/0.6 infusion in patients undergoing abdominal surgery. These hemostasis alterations were more pronounced in patients of the O blood group and may suggest a restricted intraoperative use of HES in this patients population undergoing surgical procedures with a high risk for bleeding.

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