Strauss R G, Stansfield C, Henriksen R A, Villhauer P J
Department of Pathology, University of Iowa College of Medicine, Elmer L. DeGowin Memorial Blood Center, University of Iowa Hospitals and Clinics, Iowa City.
Transfusion. 1988 May-Jun;28(3):257-60. doi: 10.1046/j.1537-2995.1988.28388219155.x.
Hetastarch, the currently marketed preparation of hydroxyethyl starch, affects coagulation by prolonging partial thromboplastin, prothrombin, and bleeding times; by lowering clotting proteins such as fibrinogen via hemodilution; by lowering clotting factor VIII (coagulant, von Willebrand antigen, and von Willebrand activity) to a greater degree than can be explained simply by hemodilution (i.e., presumably factor VIII affected by both hemodilutional plus additional, independent effects); and, finally, by shortening thrombin, reptilase, and urokinase-activated clot lysis times. Pentastarch, a new analog of hetastarch, was found to exert lesser effects on blood coagulation, despite its greater hemodiluting properties. When compared with hetastarch, pentastarch had little effect on factor VIII (except that due to hemodilution), shortened thrombin times to a significantly lesser degree, exerted no effect on the urokinase-activated clot lysis time, and did not prolong the bleeding time. Even when plasma hydroxyethyl starch levels were similar, pentastarch seemed to alter the results of coagulation assays to lesser degree than did hetastarch, which suggests the possibility of greater safety. Therefore, pentastarch may be a desirable drug, not only for leukapheresis, but also for plasma volume expansion in trauma and surgical patients who often have additional hemostatic abnormalities that place them at increased risk of hemorrhage.
羟乙基淀粉目前上市的制剂贺斯，通过延长部分凝血活酶时间、凝血酶原时间和出血时间来影响凝血；通过血液稀释降低纤维蛋白原等凝血蛋白；降低凝血因子VIII（凝血剂、血管性血友病因子抗原和血管性血友病活性）的程度大于单纯血液稀释所能解释的程度（即推测因子VIII受血液稀释及其他独立作用的影响）；最后，通过缩短凝血酶、蛇毒凝血酶和尿激酶激活的血块溶解时间来影响凝血。发现羟乙基淀粉的新类似物喷他淀粉对血液凝固的影响较小，尽管其血液稀释特性更强。与贺斯相比，喷他淀粉对因子VIII几乎没有影响（除了由于血液稀释导致的影响），凝血酶时间缩短的程度明显较小，对尿激酶激活的血块溶解时间没有影响，也不延长出血时间。即使血浆羟乙基淀粉水平相似，喷他淀粉对凝血试验结果的改变程度似乎也比贺斯小，这表明其安全性可能更高。因此，喷他淀粉可能是一种理想的药物，不仅适用于白细胞单采，也适用于创伤和手术患者的血浆容量扩充，这些患者通常存在其他止血异常，使其出血风险增加。
