Intraoperative hetastarch infusion impairs hemostasis after cardiac operations.
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.
Cope
J T
JT
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Banks
D
D
Mauney
M C
MC
Lucktong
T
T
Shockey
K S
KS
Kron
I L
IL
Tribble
C G
CG
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
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes