Comparaison des effets de l'Elohes ® et de l'albumine sur l'hémostase en chirurgie orthopédique

Abstract

A prospective study was carried out to determine the effects of Elohes ®, a low molecular weight hydroxyethylstarch, on haemostasis. Sisteen patients due to undergo total hip replacement were randomly assigned to one of two groups : group A, who were to receive up to 21 of 4 % albumin to replace blood loss, and group E, 1.5 l of Elohes ®. Patients were then given concentrated red cell packs (RCP) and lactated Ringer's solution so as to have a haematocrit value of 30 %, up to the fifth postoperative day. The amount of blood lost intraoperatively was calculated by weighing the swabs and measuring the volume aspirated. Haemostasis was investigated on the eve of surgery, 3 hours afterwards, and then every second day (days 1, 3 and 5). Total blood loss and the number of RCP transfused were similar in both groups : 1 517 ± 425 ml and 3.5 RCP, and 1 428 ± 250 ml and 3.25 RCP in groups A and E respectively. Blood albumin concentrations fell in group E as expected, the starch diluting blood proteins. Bleeding time (Simplate ®), activited partial thromboplastin time, prothrombin time changed in the same way in both groups throughout the study period after infusion of either Elohes ® or albumin. The concentrations in factors II, V, VII and X fell by 30 % three hours after surgery. Values returned to normal between days 1 and 3, the concentrations of some factors rising to values greater than preoperative values because of the postoperative inflammatory process (fibrinogen, factor VIII von Willebrand). However, there were no significant differences between the two groups. It is therefore concluded that 23.5 ml · kg −1 of Elohes ® acts on haemostasis by diluting the coagulation factors, and seems to be as safe as 4 % albumin.