Coagulation Effects of 6 % HES 130 / 0 . 4 ( Voluven ) Versus Pentastarch ( HES 200 / 0 . 5 ) : Prospective Clinical Study During Spinal Fusion Surgery

Purpose: Prospective clinical trial in patients undergoing spinal fusion surgery to assess safety aspects of voluven (6% HES 130/0.4) in comparison with 6% HES 200/0.5 solution with respect to coagulation profile. Institution: Assiut University Hospitals, Faculty of Medicine. Study Design: Fifty adult patients scheduled for elective spinal fusion surgery received one of the two solutions. GroupA: Received 6% HES 130/0.4 (Voluven). Group-B: Received pentastarch (HES 200/0.5). The treatment period were started after the induction of anesthesia and ended 5 hours after the end of surgery. Measurements: Central venous pressure (CVP), mean arterial blood pressure (MBP), and heart rate (HR) were recorded before surgery (baseline), 5hr and 24hr after surgery. Coagulation profile: Prothrombin time (PT), prothrombin concentration (PC), International Normalized Ratio (INR), partial thromboplastin time (PTT), factor VIII concentration and von Willebrand factor (VWF) and serum fibrinogen level. Samples were collected one day before surgery (baseline), at 5 hours after the end of surgery, and 24hr after surgery. Amount of given colloids (ml), blood loss (ml) and packed RBCs (ml) were recorded in all patients in both groups. Results: The patients in both groups were comparable regarding their demographic and operative data. The amount of blood loss was more in the patients of haesteril group (p 0.000) and they required more RBCs transfusion (p0.008). INR and PT were increased significantly while PC and fibrinogen were decreased significantly postoperative in both groups (p<0.05). The higher values in INR and PT and lower value in PC were for Haesteril group. In Haesteril group PTT mean values increased significantly with time when compared to basal value (p-0.001), while there was an insignificant change in voluven group. VWF was increased significantly in Voluven group 5hr and 24hr after surgery (p<0.05), and was decreased significantly in Haesteril group 5hr after surgery (p=0.04). Correspondence to: Dr. Nagw a M. Osman, The Department of Anesthesiology, Faculty of Medicine, Assiut University There was significant difference between the two groups as regard VWF, at 5hr after surgery (p=0.001). Factor VIII showed significant decreased only in Haesteril group 5hr after surgery (p0.001). Conclusion: Pentastarch (HES 200/0.5), are more likely to produce hypocoagulable effect in patients undergoing spinal fusion surgery when compared with 6% HES 130/0.4 (Voluven).