Hetastarch and bleeding complications after coronary artery surgery.
OBJECTIVE
Controversy persists concerning the potential association between intraoperative use of hetastarch (ie, hydroxyethyl starch [HES]) and postoperative bleeding in patients undergoing surgery. To determine whether intraoperative HES use is associated with an increased risk of postoperative bleeding following coronary artery bypass graft (CABG) surgery.


METHODS
Case-control study.


METHODS
A large academic medical center in the northeastern United States.


METHODS
A consecutive sample of 238 patients undergoing CABG surgery.


METHODS
Cases consisted of patients who had received either > or = 3 U packed RBCs, > or = 3 U platelets, > or= 3 U fresh frozen plasma, or any cryoprecipitate within 72 h after undergoing a CABG procedure, or who had undergone surgical revision for bleeding. All other CABG surgery patients served as control subjects.


RESULTS
In multivariate models that controlled for a wide variety of demographic and clinical characteristics, we found that, compared to patients who did not receive any HES during surgery, those who received 1 U intraoperative HES had more than twice the risk of a bleeding outcome (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.10 to 4.91), and those who received 2 or 3 U HES had more than four times the risk of postoperative bleeding (OR, 4.57; 95% CI, 1.74 to 12.00).


CONCLUSIONS
HES use in patients undergoing CABG surgery may be associated with a significant risk of postoperative bleeding. A double-blinded, randomized, controlled trial will be necessary to confirm this finding.
Avorn
Jerry
J
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. javorn@rics.bwh.harvard.edu
Patel
Minalkumar
M
Levin
Raisa
R
Winkelmayer
Wolfgang C
WC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010952:Plasma Substitutes / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes