A study of haemostasis following the use of high doses of hydroxyethyl starch 120 and dextran in major laparotomies.

The safety of plasma expanders, hydroxyethyl starch 120 and dextran 70, administered in the highest recommended doses (20 ml/kg) as adjuncts of component therapy of surgical blood loss was studied in patients undergoing major abdominal surgery and compared with a group receiving 4% albumin solution for initial haemodilution and whole blood for further blood loss replacement. Each group consisted of five patients in a relatively severe surgical, but good general condition including a normal haemostatic function and serum albumin level. The dilutional effect of the expanders on serum albumin and prothrombin-proconvertin level was observed during the day of operation. On the first postoperative day these values were equally low in all groups. Platelet count and bleeding time remained on a safe level throughout the study in all groups. Partial thromboplastic time values were unchanged. The factor VIII procoagulant (C), related antigen (R:Ag, vWF:Ag) and ristocetin cofactor levels, which were high preoperatively due to the underlying disease, remained at a safe level throughout the study. The increase in factor VIII related antigen associated with the hypercoagulable state induced by the surgical trauma was prevented by the plasma expanders. We conclude that dextran and hydroxyethyl starch can be used safely in a dose of 20 ml/kg in component therapy of surgical blood loss, provided that haematocrit is kept at an acceptable level, attention is paid to the postoperative hypoproteinaemia, and the patient has a normal haemostatic function preoperatively.