title: Postoperative blood loss and transfusion associated with use of Hextend in cardiac surgery patients at a blood conservation center.
abstract: BACKGROUND
  Hydroxyethyl starch (HES) solutions are readily available colloids, but their widespread use is shadowed by controversies surrounding their effects on bleeding. This retrospective study was conducted to evaluate the relationship between Hextend (HEX; Hospira, Inc.) doses of 1 to 20 mL/kg and allogeneic transfusion and 24-hour chest tube drainage (CTD) in cardiac surgeries at a blood conservation center.
  
  
  METHODS
  After institutional review board approval, data on 748 patients undergoing coronary artery bypass grafting (CABG), valve, or combined CABG and valve surgeries were collected. Cases not receiving HEX (due to contraindications, e.g., renal failure, bleeding diathesis) or receiving more than 20 mL per kg HEX, not accepting transfusions, or requiring more extensive surgery were excluded, and the remaining 621 cases were analyzed.
  
  
  RESULTS
  Overall transfusion rate and mean CTD were 12.7 percent and 460.4 mL, respectively. Patients who received transfusions received more HEX (10.8 mL/kg vs. 9.8 mL/kg; p = 0.043) but HEX per kg was not associated with higher transfusion rates in multivariate analysis (p = 0.077). HEX per kg was associated with CTD in both uni- and multivariate analyzes (p < 0.001) with 1.66 percent increase in CTD for every 1 mL per kg increase in HEX.
  
  
  CONCLUSIONS
  Although HEX was associated with transfusion in univariate analysis and with CTD in uni- and multivariate analysis, the former was no longer significant when adjusted for other predictors of transfusion in our selected patient population at a blood conservation center. The clinical significance of the observed increase in CTD remains undetermined. To minimize transfusion and bleeding in these patients, it is recommended that HEX be used in amounts of not more than 20 mL per kg together with point-of-care coagulation tests and other blood conservation strategies.
authors.affiliation: Englewood Hospital and Medical Center, Englewood, New Jersey 07631, USA. david.moskowitz@ehmc.com
authors.forename: David M
authors.initials: DM
authors.lastname: Moskowitz
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shander
authors.forename: Mazyar
authors.initials: M
authors.lastname: Javidroozi
authors.forename: James J
authors.initials: JJ
authors.lastname: Klein
authors.forename: Seth I
authors.initials: SI
authors.lastname: Perelman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nemeth
authors.forename: M Arisan
authors.initials: MA
authors.lastname: Ergin
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012189:Retrospective Studies; D013903:Thoracic Surgery
chemical_list: D006895:Hydroxyethyl Starch Derivatives