• Kirsten C Rasmussen, Pär I Johansson, Michael Højskov, Irina Kridina, Thomas Kistorp, Peter Thind, Henning B Nielsen, Birgitte Ruhnau, Tom Pedersen, and Niels H Secher.
• *Department of Anesthesiology, The Abdominal Centre †Section for Transfusion Medicine ‡Department of Urology; and §Center of Head and Ortopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark.
• Ann. Surg.. 2014 Feb 1;259(2):249-54.

ObjectiveThis study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss.BackgroundArtificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius Kabi, Uppsala, Sweden) only a minor effect on coagulation competence is expected.MethodsEighty patients were scanned for enrollment in the study, and 40 patients fulfilled the inclusion criteria. Two patients withdrew their consent to participate in the study, and 5 patients were excluded. Thus, 16 patients were randomized to receive lactated Ringer's solution and 17 to receive HES 130/0.4.ResultsAmong the patients receiving HES 130/0.4, thrombelastography indicated reduced clot strength (P < 0.001) and blinded evaluation of the perioperative blood loss was 2.2 (range 0.5 to 5.0) versus 1.4 (range 0.5 to 2.4) L in the patients who received HES 130/0.4 or lactated Ringer, respectively (P < 0.038). The patients in the lactated Ringer's group, however, received more fluid (P < 0.0001) than those in the HES 130/0.4 group. There was no significant difference between the 2 groups with regard to frequency of reoperations or the length of hospital stay, but use of HES 130/0.4 was both more expensive and less efficacious than the use of lactated Ringer.ConclusionsAdministration of HES 130/0.4 reduced clot strength and perioperative hemorrhage increased by more than 50%, while administration of lactated Ringer's solution provoked an approximately 2.5 times greater positive volume balance at the end of surgery.

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