title: Hetastarch increases the risk of bleeding complications in patients after off-pump coronary bypass surgery: a randomized clinical trial.
abstract: OBJECTIVE
  Hetastarch is an artificial colloid widely used intraoperatively in fluid-replacement regimens. Previous studies have found that the intraoperative administration of hetastarch may increase the risk of postoperative bleeding in patients who undergo coronary artery bypass graft surgery with cardiopulmonary bypass. Previous published reports have not examined this risk in patients who underwent coronary artery bypass grafting without cardiopulmonary bypass.
  
  
  METHODS
  In a randomized clinical trial, 156 patients undergoing off-pump coronary artery bypass grafting were assigned to receive either 1 liter of hetastarch or 1 liter of albumin as part of intraoperative volume replacement. Sample recruitment was halted in a review per protocol by the study's Data Safety Monitoring Committee. We assessed the rate of postoperative bleeding by monitoring the number of units of blood products transfused in the first 24 postoperative hours in the intensive care unit and the hourly chest tube drainage in the first 12 postoperative hours.
  
  
  RESULTS
  Intraoperative administration of 1 liter of hetastarch was associated with statistically significant increases in 3 measures: transfusion requirements on postoperative day 1 (red blood cells, 1.14 vs 0.40 units, P = .017; fresh-frozen plasma, 0.57 vs 0.15, P = .009; platelets, 0.35 vs 0.10, P = .013); the overall likelihood of receiving transfusion on postoperative day 1 (46.2% vs 25.6%, P = .012); and the volume of chest tube drainage in the first 12 hours postoperatively (732.0 vs 563.6 mL, P < .001).
  
  
  CONCLUSIONS
  In patients undergoing off-pump coronary artery bypass, the intraoperative administration of hetastarch increases the postoperative transfusion requirement and the volume of blood drained postoperatively.
authors.affiliation: Kaiser Permanente Medical Center, Oakland, Calif, USA. howardbarkan@cs.com
authors.forename: Marketa
authors.initials: M
authors.lastname: Hecht-Dolnik
authors.forename: Howard
authors.initials: H
authors.lastname: Barkan
authors.forename: Ananse
authors.initials: A
authors.lastname: Taharka
authors.forename: John
authors.initials: J
authors.lastname: Loftus
mesh_terms: D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control* / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015992:Body Mass Index; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D007430:Intraoperative Care / Q000009:adverse effects; D007902:Length of Stay; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010952:Plasma Substitutes / Q000009:adverse effects; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes