The effect of haemodilution with 6% hydroxyethyl starch (130/0.4) on haemostasis in pregnancy
April 13, 2010
| Abstract Title: | The effect of haemodilution with 6% hydroxyethyl starch (130/0.4) on haemostasis in pregnancy. An in vitro assessment using thromboelastometry |
| Authors: | Teodorescu Andrei George*, Aurel Ardelean*, Teodorescu Petre Octavian**, Chipurici Otilia** |
| Affiliation: | * „Vasile Goldiş” Western University of Arad, Romania ** University of Oradea, Romania |
| Abstract text: | Hydroxyethyl starches (HES) are more effective than Ringer Lactate (RL) in maintaining or expanding blood volume, but their use is limited by concerns over their effect on haemostasis. Late Pregnancy is characterized by increased blood coagulability. The aim of this study is to evaluate the effect of haemodilution to 60 % using RL, or a mixture of RL and 6 % HES (130/0.4) on blood haemostasis in pregnant women at term presenting for elective caesarean section using thromboelastometry. After obtaining the hospital ethical committee approval, and written informed consent, 8 patients presenting for elective caesarean section were included. Patients were ASA I with a singleton term pregnancy. None of them were on aspirin, anticoagulants or NSAID. Before starting the intravenous fluids, a blood sample was drawn into glass blood collection tube containing 0.129 M trisodium citrate. Using thromboelastometry (ROTEM) each citrated blood sample was analyzed undiluted (baseline), diluted to 60 % using RL or a mixture of RL and HES at a ratio of 1:1. ROTEM measurements were performed using 300 μl of blood at 37°c. Measurements included EXTEM coagulation time (CT), ciot formation time (CFT) which reflects ciot initiation and propagation respectively, alpha angle and maximum ciot firmness (MCF) for assessing ciot formation kinetics and quality, FIBTEM maximum ciot firmness (MCF) for assessing fibrinogen activity and polymerization. Sample size calculation showed that 8 patients should be included in the two treatment groups in order to detect a difference of 1.2 mm in MCF value using FIBTEM. The data were analyzed using paired two-tailed t-test. P-value of 0.05 was used as the level of significance. A significant impairment of EXTEM variables CT, CFT, alpha angle and MCF and also FIBTEM MCF were observed in both dilutions. Significant impairment was observed in RL & HES combination compared to RL alone (P value < 0.05). CT: clotting time, CFT: ciot formation time, MCF: maximum ciot firmness. Data expressed as mean (SD). Against baseline *P value < 0.001 - Against RL 1P value < 0.05. Haemodilution in pregnant women with RL alone causes less impairment of coaguiation parameters compared to RL/HES combination. |
| Keywords: | 6% hydroxyethyl starch (130/0.4), thromboelastometry, haemostasis, Ringer Lactate, pregnancy |
| Presentation type: | Oral |
| Correspondence: | no. 1 Feleacului St., Arad, Romania |
| Email: | teodorescu_andrei_george@yahoo.com |
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