title: Intraoperative hetastarch infusion impairs hemostasis after cardiac operations.
abstract: BACKGROUND
  An outbreak of excessive bleeding after cardiac operations occurred at our institution when 5% albumin was in short supply and hetastarch became the preferred intraoperative colloid. As hetastarch may impair coagulation, we investigated the effects of its intraoperative administration on post-cardiac surgical hemostasis.
  
  
  METHODS
  Indices of postoperative hemostasis were analyzed in 189 consecutive patients undergoing coronary artery bypass grafting. Three groups were compared: one group (n = 68) received a mean of 796 mL of hetastarch only in the operating room (a few minutes after cessation of cardiopulmonary bypass), another group (n = 59) received a mean of 856 mL postoperatively only, and a third group (n = 62) received no hetastarch.
  
  
  RESULTS
  Compared with the other two groups, those patients administered hetastarch intraoperatively exhibited significant reductions in hematocrit and platelet count, a significant prolongation in the prothrombin time, and significant increases in both blood loss and hemostatic drug requirement. Also identified were obvious trends toward a greater transfusion requirement and reexploration rate for bleeding in the latter group.
  
  
  CONCLUSIONS
  Hetastarch infusion just after weaning from cardiopulmonary bypass produces a clinically important impairment in post-cardiac surgical hemostasis. Intraoperative use of this agent during heart operations should be avoided until the safe timing of its administration is clarified.
authors.affiliation: Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Cope
authors.forename: D
authors.initials: D
authors.lastname: Banks
authors.forename: M C
authors.initials: MC
authors.lastname: Mauney
authors.forename: T
authors.initials: T
authors.lastname: Lucktong
authors.forename: K S
authors.initials: KS
authors.lastname: Shockey
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
authors.forename: C G
authors.initials: CG
authors.lastname: Tribble
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D001026:Coronary Artery Bypass; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000627:therapeutic use; D007430:Intraoperative Care; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects* / Q000627:therapeutic use; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes