Molar substitution and C2/C6 ratio of hydroxyethyl starch: influence of blood coagulation

Résumé Cette étude a démontré l'effet individuel sur la coagulation sanguine humaine des deux principales caractéristiques de la molécule d'hydroxyéthylamidon (HES) : la substitution molaire et le rapport C2/C6. L'analyse par thrombélastographe (TEG®) indique que la molécule de HES dont la substitution molaire est de 0.42 et le rapport C2/C6 de 2.7 a le moins d'effet sur la coagulation sanguine chez l'être humain. Objectifs de l'étude Le développement d'hydroxyéthylamidons (HES) qui ont à la fois peu d'impact sur la coagulation sanguine et une longue persistance intravasculaire est d'un grand intérêt clinique. Une précédente étude in vitro a démontré qu'une solution de HES de haut poids moléculaire et de bas degré de substitution molaire ne compromettait pas plus la coagulation sanguine qu'une solution HES de poids moléculaire moyen (1). La présente étude examine l'effet individuel de la substitution molaire et du rapport C2/C6 d'une solution de HES de haut poids moléculaire (700 kDa) sur la coagulation sanguine. Matériel et méthode Nous avons prélevé du sang chez 30 adultes en bonne santé; le sang a été mélangé avec 6 solutions de HES qui diffèrent par leur degré de substitution molaire (0.42 et 0.51) et leur rapport C2/C6 (2.7, 7 et 14) à trois degrés de dilution : 20%, 40% et 60%. Les échantillons ont ensuite été analysés par thrombélastographe. Les données ont été étudiées par analyse de variance à trois voies pour mesures répétées sur une voie (dilution). Résultats Plus la substitution molaire est élevée, plus la coagulation sanguine est compromise et ce concernant tous les paramètres du TEG® (tous les p sont < à 0.05). La solution HES avec le rapport C2/C6 le plus bas a l'effet le moins prononcé sur le temps r (p<0.001), l'angle α (p=0.003) et l'Index de Coagulation CI (p<0.001) ; on n'a pas observé d'effet sur le temps k (p=0.513) et l'amplitude maximale (p=0.699) concernant ce paramètre. Conclusion L'analyse par thrombélastographe révèle qu'une molécule de HES avec une substitution molaire de 0.42 et un rapport C2/C6 de 2.7 a un effet minimal sur la coagulation sanguine humaine in vitro

Molar substitution and C2/C6 ratio of hydroxyethyl starch: influence on blood coagulation

Background. Development of hydroxyethyl starches (HES) with a low impact on blood coagulation but a long intravascular persistence is of clinical interest. A previous in vitro study showed that low substituted high molecular weight HES does not compromise blood coagulation more than medium molecular weight HES. In the present study we assessed the individual effects on blood coagulation of molar substitution and C2/C6 ratio of a high molecular weight HES. Methods. Blood was obtained from 30 healthy patients undergoing elective surgery and mixed with six high molecular weight (700 kDa) HES solutions differing in their molar substitution (0.42 and 0.51) and C2/C6 ratio (2.7, 7 and 14) to achieve 20, 40 and 60% dilution. Blood coagulation was assessed by Thrombelastograph® analysis (TEG) and plasma coagulation tests.Data were compared using a three-way analysis of variance model with repeated measures on the three factors. Results. Higher molar substitution compromised blood coagulation most (for all TEG parameters, P0.50). The higher molar substitution was associated with a lesser increase in PT (P=0.007) and a greater decrease in factor VIII (P=0.010). PTT, functional and antigenic von Willebrand factors were not significantly influenced by molar substitution (P for all >0.20). No significant differences between solutions with the same molar substitution but different C2/C6 ratios were found in plasma coagulation parameters (P for all >0.05). Conclusions. TEG analysis indicates that high molecular HES with a molar substitution of 0.42 and a C2/C6 ratio of 2.7 has the lowest effect on in vitro human blood coagulatio

Molar substitution and C2/C6 ratio of hydroxyethyl starch: influence on blood coagulation

BACKGROUND: Development of hydroxyethyl starches (HES) with a low impact on blood coagulation but a long intravascular persistence is of clinical interest. A previous in vitro study showed that low substituted high molecular weight HES does not compromise blood coagulation more than medium molecular weight HES. In the present study we assessed the individual effects on blood coagulation of molar substitution and C2/C6 ratio of a high molecular weight HES. METHODS: Blood was obtained from 30 healthy patients undergoing elective surgery and mixed with six high molecular weight (700 kDa) HES solutions differing in their molar substitution (0.42 and 0.51) and C2/C6 ratio (2.7, 7 and 14) to achieve 20, 40 and 60% dilution. Blood coagulation was assessed by Thrombelastograph analysis (TEG) and plasma coagulation tests. Data were compared using a three-way analysis of variance model with repeated measures on the three factors. RESULTS: Higher molar substitution compromised blood coagulation most (for all TEG parameters, P<0.05). The lowest C2/C6 ratio was associated with the lowest effect on blood coagulation; r (P<0.001), angle alpha (P=0.003) and coagulation index (P<0.001). No effect on k and maximum amplitude was observed (P for both >0.50). The higher molar substitution was associated with a lesser increase in PT (P=0.007) and a greater decrease in factor VIII (P=0.010). PTT, functional and antigenic von Willebrand factors were not significantly influenced by molar substitution (P for all >0.20). No significant differences between solutions with the same molar substitution but different C2/C6 ratios were found in plasma coagulation parameters (P for all >0.05). CONCLUSIONS: TEG analysis indicates that high molecular HES with a molar substitution of 0.42 and a C2/C6 ratio of 2.7 has the lowest effect on in vitro human blood coagulation

Researchers’ attitudes to the 3Rs - An upturned hierarchy?

Animal use in biomedical research is generally justified by its potential benefits to the health of humans, or other animals, or the environment. However, ethical acceptability also requires scientists to limit harm to animals in their research. Training in laboratory animal science (LAS) helps scientists to do this by promoting best practice and the 3Rs. This study evaluated scientists’ awareness and application of the 3Rs, and their approach to other ethical issues in animal research. It was based on an online survey of participants in LAS courses held in eight venues in four European countries: Portugal (Porto, Braga), Germany (Munich, Heidelberg), Switzerland (Basel, Lausanne, Zurich), and Denmark (Copenhagen). The survey questions were designed to assess general attitudes to animal use in biomedical research, Replacement alternatives, Reduction and Refinement conflicts, and harm-benefit analysis. The survey was conducted twice: immediately before the course (‘BC’, N = 310) and as a follow-up six months after the course (‘AC’, N = 127). While courses do appear to raise awareness of the 3Rs, they had no measurable effect on the existing low level of belief that animal experimentation can be fully replaced by non-animal methods. Most researchers acknowledged ethical issues with their work and reported that they discussed these with their peers. The level of an animal’s welfare, and especially the prevention of pain, was regarded as the most pressing ethical issue, and as more important than the number of animals used or the use of animals as such. Refinement was considered more feasible than Replacement, as well as more urgent, and was also favoured over Reduction. Respondents in the survey reversed the ‘hierarchy’ of the 3Rs proposed by their architects, Russell and Burch, prioritizing Refinement over Reduction, and Reduction over Replacement. This ordering may conflict with the expectations of the public and regulators.</div

Novel starches: single-dose pharmacokinetics and effects on blood coagulation.

BACKGROUND: Carboxymethyl starch (CMS) and carboxymethylated hydroxyethyl starch (CM-HES) might offer advantages over hydroxyethyl starch (HES) with regard to their volume expansion effect and their pharmacokinetic characteristics. The goal of the current study was to determine the pharmacokinetics of CMS and CM-HES and to investigate their influence on blood coagulation in comparison with the standard low-molecular, low-substituted HES (130/0.42) used in Europe. METHODS: The study was conducted as a randomized, blinded, parallel three-group study in 30 pigs. Twenty ml/kg of 6% HES (control), 6% CMS, or 6% CM-HES was infused as a single dose, and serial blood sampling was performed over 20 h to measure plasma concentration and molecular weight and to assess blood coagulation. Concentration-effect relations were assessed by pharmacokinetic-pharmacodynamic analysis. RESULTS: CMS and CM-HES showed significantly higher plasma concentrations and molecular weights over 20 h (P for both&amp;lt;0.001) with smaller volumes of distribution and longer elimination rates during the terminal phase (P for both&amp;lt;0.01) when compared with HES. CMS and CM-HES impaired whole blood coagulation more than HES as assessed by Thrombelastograph analysis (Haemoscope Corporation, Niles, IL). However, similar effects of all three starch preparations on blood coagulation were found when related to the plasma concentrations in mass units. CONCLUSIONS: Carboxymethylation of starch results in an increased intravascular persistence and a slower fragmentation compared with HES. The greater impairment of blood coagulation by CMS and CM-HES seems to be caused by the higher plasma concentrations