Hydroxyethyl starch and coagulation

  • J. Treib
  • M. T. Grauer
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Hydroxyethyl starch (HES) is one of the most frequently used volume replacement agents. Its advantages, such as high efficacy, few allergic reactions, low cost and general availability, are generally acknowledged. The main disadvantage of HES is its adverse effects on coagulation and resulting hemorrhagic complications. During recent years, studies have been carried out that attempted to examine how HES affects rheology and coagulation, to what extent these effects are clinically relevant and how they can be avoided. Since the first reports of bleeding complications were published in the 1980s, several new types of HES have entered the market, giving the physician a greater choice and the opportunity to avoid some of the undesired side effects of HES.


Hydroxyethyl Starch Plasma Viscosity Erythrocyte Aggregation Hydroxyethyl Group Stroke Study Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    London MJ, Ho Js, Triedman JK, Verrier ED, Levine J, Merrick SH, Hanley FL, Browner WS, Mangono DT (1989) A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg 97:785–797.PubMedGoogle Scholar
  2. 2.
    Shoemaker WC, Kram HB (1990) Effects of crystalloids and colloids on hemodynamics, oxygen transport and outcome in high-risk surgical patients. In: Simmons RC, Udekuo AS (eds) Debates in clinical surgery. Yearbook, Chicago, pp 263–316.Google Scholar
  3. 3.
    Arend O, Hoberg A, Bertram B, Reim M, Wolf S (1991) Hemodilution in acute arterial circulatory disorders of the retina. Acta-Med-Austriaca 18(Suppl 1):66–68.PubMedGoogle Scholar
  4. 4.
    Zennaro O, Dauman R, Poisot A, Esteben D, Duclose JY, Bertrand B, Cros AM, Milacic M, Bebear JP (1993) Value of the association of normovolemic dilution and hyperbaric oxygenation in the treatment of sudden deafness. A retrospective study. Ann Otolaryngol Chir Cervicofac 110:162–169.PubMedGoogle Scholar
  5. 5.
    Kiesewetter H, Jung F, Blume J, Gerhards M (1987) Hämodilution bei Patienten mit peripherer arterieller Verschlußkrankheit im Stadium IIb: prospektiver randomisierter Doppelblind-Vergleich von mittelmolekularer Hydroxyethylstärke und kleinmolekularer Dextranlösung. Klin Wschr 65:324–330.PubMedCrossRefGoogle Scholar
  6. 6.
    The Hemodilution in Stroke Study Group (1989) Hypervolemic hemodilution treatment of acute stroke. Results of a randomized multicenter trial using pentastarch. Stroke 20:317–323.Google Scholar
  7. 7.
    Koller M, Haenny P, Hess K, Weniger D, Zangger P (1990) Adjusted hypervolemic hemodilution in acute ischemic stroke. Stroke 21:1429–1434.PubMedCrossRefGoogle Scholar
  8. 8.
    Haass A, Stoll M, Treib J (1992) Hemodilution in cerebral circulatory disturbances: indications, implementation additional drug treatment and alternatives. In Hemodilution. New aspects in the management of circulatory blood flow. Improvement of macro-and microcirculation. Springer-Verlag, Berlin Heidelberg New York, pp 53–114Google Scholar
  9. 9.
    Scandinavian Stroke Study Group (1987) Multicenter trial of hemodilution in acute ischemic stroke. Stroke 18:691–699CrossRefGoogle Scholar
  10. 10.
    Italian Acute Stroke Study Group (1988) Hemodilution in acute stroke. Results of the Italian hemodilution trial. The Lancet 13:318–320.Google Scholar
  11. 11.
    Mori K, Arai H, Nakajima K, Tajima A, Maeda M (1995) Hemorheological and hemodynamic analysis of hypervolemic hemodilution therapy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 26:1620–1626.PubMedCrossRefGoogle Scholar
  12. 12.
    Symington BE (1986) Hetastarch and bleeding complication. Ann Intern Med 105:627–628.PubMedGoogle Scholar
  13. 13.
    Cully MD, Larson CP, Silverberg GD (1987) Hetastarch coagulopathy in a neurosurgical patient. Anaesthesiology 66:707–708.CrossRefGoogle Scholar
  14. 14.
    Damon L, Adams M, Strieker RB, Ries C (1987) Intracranial bleeding during treatment with hydroxyethyl starch. N Engl J Med 317:964–965.PubMedGoogle Scholar
  15. 15.
    Chang JC, Gross HM, Jang NS (1990) Disseminated intravascular coagulation due to intravenous administration of hetastarch. Am J Sci 300:301–303.Google Scholar
  16. 16.
    Trumble ER, Muizelaar JP, Myseros JS, Choi SC, Warren BB (1995) Coagulopathy with the use of hetastarch in the treatment of vasospasm. J Neurosurg 82:44–47.PubMedCrossRefGoogle Scholar
  17. 17.
    van den Brink WA, van Genderen P, Thijsse WJ, Michiels JJ (1996) Hetastarch coagulopathy. J Neurosurg 85:367.Google Scholar
  18. 18.
    Sanfelippo MJ, Suberviola PD, Geimer NF (1987) Development of a von Willebrand like syndrome after prolonged use of hydroxyethyl starch. Am J Clin Pathol 88:653–655.PubMedGoogle Scholar
  19. 19.
    Dalrymple HM, Aitchison R, Collins P, Sekhar M, Colvin B (1992) Hydroxyethyl starch induced acquired von Willebrand’s disease. Clin Lab Haematol 14:209–211.CrossRefGoogle Scholar
  20. 20.
    Conroy JM, Fishman RL, Reeves ST, Pinosky ML, Lazzarchick J (1996) The effect of desmopressin and 6% hydroxyethyl starch on factor VIII:C. Anaesth Analg 83:804–807.Google Scholar
  21. 21.
    Treib J, Haass A, Pindur G, Seyfert UT, Treib W, Grauer MT, Jung F, Wenzel E, Schimrigk K (1995) HES 200/0.5 is not HES 200/0.5. Influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics. Thromb Haemost 74:1452–1456.PubMedGoogle Scholar
  22. 22.
    Mishler JM, Ricketts CR, Parkhouse EJ (1980) Post-transfusion survival of hydroxyethyl starch 450/0.70 in man: a long-term study. J Clin Pathol 33:155–159.PubMedCrossRefGoogle Scholar
  23. 23.
    Ferber HP, Nitsch E, Forster H (1985) Studies on hydroxyethyl starch. Part II: Changes of the molecular weight distribution for hydroxyethyl starch types 450/0.7, 450/0.5, 450/0.3, 300/0.4, 200/0.7, 200/0.5, 200/0.3 and 200/0.1 after infusion in serum and urine of volunteers. Arzneimittelforschung 35:615–622.PubMedGoogle Scholar
  24. 24.
    Korttila K, Grohn P, Gordin A, Sundberg S, Salo H, Nissinen E, Mattila MA (1984) Effect of hydroxyethyl starch and dextran on plasma volume and blood hemostasis and coagulation. J Clin Pharmacol 24:273–282.PubMedGoogle Scholar
  25. 25.
    Degremont AC, Ismail M, Arthaud M, Oulare B, Mundler O, Paris M, Baron JF (1995) Mechanisms of postoperative prolonged plasma volume expansion with low molecular weight hydroxyethyl starch (HES 200/0.62, 6%). Intensive Care Med 21:577–583.PubMedCrossRefGoogle Scholar
  26. 26.
    Treib J, Haass A, Pindur G, Grauer MT, Wenzel E, Schimrigk K (1996) All medium starches are not the same. Influence of degree of substitution of hydroxyethyl starch on plasma volume, hemorheologic conditions, and coagulation. Transfusion 36:450–455.PubMedCrossRefGoogle Scholar
  27. 27.
    Treib J, Haass A, Pindur G, Grauer MT, Seyfert UT, Treib W, Wenzel E, Schimrigk K (1996) Influence of low molecular weight hydroxyethyl starch on hemostasis and hemorheology. Haemostasis 26:258–265.PubMedGoogle Scholar
  28. 28.
    Treib J, Haass A, Pindur G, Miyachita C, Grauer MT, Jung F, Wenzel E, Schimrigk K (1996) Highly substituted hydroxyethyl starch (HES 200/0.62) leads to a type I von Willebrand syndrome after repeated administration. Haemostasis 26:210–213.PubMedGoogle Scholar
  29. 29.
    Treib J, Haass A, Pindur G, Grauer MT, Treib W, Wenzel E, Schimrigk K (1997) Increased hemorrhagic risk after repeated infusion of highly substituted medium molecular weight hydroxyethyl starch. Drug Res 47:18–22.Google Scholar
  30. 30.
    Treib J, Haass A, Pindur G, Grauer MT, Wenzel E, Schimrigk K (1997) Avoiding an impairment of F VIII:C by using hydroxyethyl starch with a low in vivo molecular weight. Anesth Analg 84:1391.PubMedGoogle Scholar
  31. 31.
    Treib J, Haass A, Pindur G (1997) Coagulation disorders caused by hydroxyethyl starch. Thromb Haemost 78:974–983.PubMedGoogle Scholar
  32. 32.
    Peter K, Gander HP, Lutz H, Nold W, Strosiek U (1975) Die Beeinflussung der Blutgerinnung durch Hydroxyäthylstärke. Anaesthesist 24:219–224.PubMedGoogle Scholar
  33. 33.
    Vinazzer H, Bergmann H (1975) Zur Beeinflussung postoperativer Änderungen der Blutgerinnung durch Hydroxyäthylstärke. Anaesthesist 24:517–520.PubMedGoogle Scholar
  34. 34.
    Probst W (1988) Elohäst (Hydroxyethylstärke 6% 200/0.60-0.66) bei akuten ischämischen cerebralen Durchblutungsstörungen. Elohäst Workshop, pp 11–12.Google Scholar
  35. 35.
    Reiger I (1988) Erfahrungen mit Elohäst (Hydroxyethylstärke 6% 200/0.60-0.66) in der Therapie des Cerebralinsults. Elohäst Workshop, p 10.Google Scholar
  36. 36.
    Ruggeri ZM (1994) Pathogenesis and classification of von Willebrand disease. Haemostasis 24:265–275.PubMedGoogle Scholar
  37. 37.
    Zimmerman TS, Ruggeri ZM (1983) Von Willebrand’s Disease. Clin Haematol 12:175–200.PubMedGoogle Scholar
  38. 38.
    Grauer MT, Treib J (1998) The effect of HES on coagulation is difficult to assess in vitro. Br J Anaesth 80:125–126.PubMedCrossRefGoogle Scholar
  39. 39.
    Siostrzonek P, Niessner H, Deutsch E, Lechner K, Korninger C, Pabinger I, Heinz R (1985) Vier Fälle mit erworbenem von Willebrand-Syndrom und monoklonaler Gammopathie. Langzeitverlauf sowie diagnostische und therapeutische Problematik. In: Landbeck G (ed) Hämophilie Symposium. Springer-Verlag, Berlin Heidelberg New York, pp 248–256.Google Scholar
  40. 40.
    Kohler H, Zschiedrich H, Clasen R, Linfante A, Gamm H (1982) The effects of 500 ml 10% hydroxyethyl starch 200/0.5 and 10% dextran 40 on blood volume, colloid osmotic pressure and renal function in human volunteers. Anaesthesist 31:61–67PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • J. Treib
  • M. T. Grauer

There are no affiliations available

Personalised recommendations