To: Jim Roof who wrote (843 ) 4/22/1998 12:32:00 PM From: Stephen How Read Replies (1) | Respond to of 1432
Jim, you're right, I should not have included platelet count as being affected by hetastarch. From (Thromb Haemost 1997; 78: 974-83):"Studies to date have not demonstrated a HES solution that induces a decline in platelet number beyond that caused by the dilution effect." However, reasearchers point to increased PT and PTT times as being highly increased by hetastarch, more than by mere dilution. From the same reference:"The prolonged aPTT time shows a disorder of the intrinsic clotting system caused mainly through a change in factor VIII/von Willibrand factor. Von Willebrand factor supports the adhesion of the platelets to the injured blood vessel. A decrease in factor VIII/von Willebrand factor rarely leads to spontaneous bleeding but may considerably prolong after-bleeding from even small injuries." A study graphed PTT vs. time (days) increasing the first day of surgery, then relaxing back to their pre-surgery times in a few days. The study compared the graphs for hetastarch and control (PPF) group patients. In the first day, the hetastarch group jumped from a PTT of 30 sec to 45 sec, while the control group went from 34 sec to 39 sec (preop to postop). Similarly, the PT times for the hetastarch group jumped from 11.5 sec to 12.5 sec, but the control (PPF) group didn't show any jump. [From Arch Surg 1983; 118:804-9. It's the study that safely administered 5 L hetastarch to 4 patients in their first 24 h, and safely administered 15 L to another patient in 24 h.] I was saying in my previous post that the jumps in PT and PTT times for Hextend® looked very much like that for hetastarch (p>.05). In a control group, the preop/postop PT and PTT times did not show this large increase. This is why I said "tell-tale effects of hetastarch". Steve