Hypervolumetric hemodilution with HES 100/0.5 10% in patients with peripheral arterial occlusive disease (Fontaine, stage II): An open clinical and pharmacological phase IV study
Affiliations: Institute for Transfusion Medicine, University Clinic, Medical School of the Humboldt University, Campus Charité Mitte, Schumannstr. 20/21, D‐10117 Berlin, Germany | Dresdner Institut für Herz‐ und Kreislaufforschung e.V., Forststr. 5, D‐01099 Dresden, Germany | Arbeitsgruppe zur Systemoptimierung klinischer Forschungsprojekte, Institut für Systemwissenschaften an der Johannes Kepler Universität, Altenbergstr. 69, A‐4040 Linz, Austria
Note: [] Corresponding author: Dr J. Koscielny, Institute for Transfusion Medicine, University Clinic, Medical School of the Humboldt University, Campus Charité Mitte, Schumannstr. 20/21, D‐10117 Berlin, Germany. Fax: + 49 30 2802 1179.
Abstract: The efficacy of three weekly interventions with hypervolumetric hemodilution of a new preparation of hydroxyethyl starch (HES 100/0.5, 10%, C2/C6 substitution ratio of 6.5) on pain‐free walking distance of patients with peripheral arterial occlusive disease (PAOD) stage IIb on the Fontaine classification was investigated. In addition quantitative data on the pharmacokinetic properties of this HES preparation, and it’s impact on hemorheology, hemostasis and homeostasis were shown. Ten patients were included according to a predefined protocol, and treated openly with 500 ml HES 100/0.5 10% on nine occasions over 18 days. Pain‐free walking distance, the main outcome measure, showed a mean increase of 82 m (+60%). Hematocrit decreased 4 percentage points on average (5.5 percentage points one hour after interventions). Plasma viscosity dropped 5% on average with significant changes immediately after interventions only in patients whose baseline values had been equal to or above the 2 s reference area. Erythrocyte aggregation decreased by 16% in the course of treatment (8% immediately after interventions), systolic blood pressure by 13%, and total protein by 7%. Complement showed a trend towards lower values (-20%), and creatinine, pH and urine viscosity remained unchanged. Apart from complement changes, all reductions mirrored the dilution effects. As to pharmacokinetics, serum mean molecular weight distribution was very similar to that of the infusion. A minor adverse drug reaction (light, spontaneously disappearing pruritus) was observed in one case.
