Thromboelastometric assessment of hemostasis following hydroxyethyl starch (130/0.4) administration as a constant rate infusion in hypoalbuminemic dogs.

Abstract

BACKGROUND: The primary aim was to evaluate by means of thromboelastometry (ROTEM) the effects of hydroxyethyl starch (HES) 130/0.4 administered as a constant rate infusion (CRI) on hemostasis in hypoalbuminemic dogs. The second aim was to use ROTEM analysis to detect whether all hypoalbuminemic dogs of our population were hypercoagulable. RESULTS: The study sample was 20 hypoalbuminemic dogs (albumin <&#x2009;2&#xa0;g/dl) with normal perfusion parameters and requiring intravenous fluid therapy. In order to support plasma colloid osmotic pressure, in addition to crystalloid, HES 130/0.4 was administered as a constant rate infusion at 1&#xa0;ml/kg/h (group 1, n&#x2009;=&#x2009;11) or 2&#xa0;ml/kg/h for 24&#xa0;h (group 2, n&#x2009;=&#x2009;9). Blood samples were collected at baseline (T0) and 24&#xa0;h postinfusion (T1); coagulation was assessed by standard coagulation profile (prothrombin time, activated partial thromboplastin time, and fibrinogen), and ROTEM analysis (in-TEM&#xae;, ex-TEM&#xae; and fib- TEM&#xae; profile). No statistically significant differences in ROTEM values in group 1 were observed (P&#x2009;>&#x2009;0.05), whereas in group 2 statistically significant differences (P&#x2009;<&#x2009;0.05) were found at T1 in the in-TEM&#xae; profile [decrease in clot formation time (P&#x2009;=&#x2009;0.04) and increase in &#x3b1; angle (P&#x2009;=&#x2009;0.02)] and in the ex-TEM&#xae; profile [increase in maximum clot firmness (P&#x2009;=&#x2009;0.008) and &#x3b1; angle (P&#x2009;=&#x2009;0.01)]; no changes were identified in the fib-TEM&#xae; profile. In both groups, a statistically significant decrease (P&#x2009;=&#x2009;0.007) in hematocrit was noted, whereas no statistically significant differences in platelet count and standard coagulation profile were found. In group 2, a statistically significant increase in TS values (P&#x2009;=&#x2009;0.03) was noted at T1. ROTEM tracings indicating a hypercoagulable state were observed in 7/20 dogs at T0 (5/11 in group 1 and 2/9 in the group 2). CONCLUSION: Our findings suggest that HES 130/0.4 administered as CRI does not cause hypocoagulability in hypoalbuminemic dogs. A trend toward hypercoagulability, probably related to the underlying diseases, was observed in group 2 at T1. Although all dogs were hyoalbuminemic, only 7/20 were hypercoagulable at T0, confirming the lack of correlation between albumin level and prothrombotic state.