Hydroxyethyl starch (hetastarch) is a colloid solution available in the United States as a 6% solution in 0.9% NaCl (Hespan), as well as Hextend. The larger molecules (the range is from 10,000 to 2 million daltons) of Hespan are degraded by amylase. Hydroxyethyl starch is stored in the reticuloendothelial system for hours and is thought to be renally excreted.
Its coagulation effects include a dilutional effect, reduction in factor VIII and vWF levels, reduction in glycoprotein IIb/IIIa availability (interferes with platelet adhesion), and direct movement into fibrin clots.
Allergic reactions and bleeding have been described with doses of 20 mL/kg or higher
Hextend is another hydroxyethyl with smaller units, which may not affect coagulation as much as as Hespan
Coagulation Effects of Hydroxyethyl starch
- Reduction in factor VIII and vWF levels
- Reduction in glycoprotein IIb/IIIa availability
- Direct movement into fibrin clots
Hetastarch: Coag effect