The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 3 , Pages 703-711, September 2009

Hetastarch increases the risk of bleeding complications in patients after off-pump coronary bypass surgery: A randomized clinical trial

  • Marketa Hecht-Dolnik, MD

      Affiliations

    • Kaiser Permanente Medical Center, Oakland, Calif
    • ,
  • Howard Barkan, DrPH

      Affiliations

    • University of California, Berkeley, Calif
    • Corresponding Author InformationAddress for reprints: Howard Barkan, DrPH, University of California Berkeley Joint Medical Program, School of Public Health, 1411 Arch Street, Berkeley, CA 94708.
    • ,
  • Ananse Taharka, MD

      Affiliations

    • Kaiser Permanente Medical Center, Oakland, Calif
    • ,
  • John Loftus, MD

      Affiliations

    • Kaiser Permanente Medical Center, Oakland, Calif

Received 16 September 2008; received in revised form 30 December 2008; accepted 16 February 2009. published online 28 May 2009.

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).

Conclusion

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.

Abbreviations and Acronyms: BMI, body mass index, CABG, coronary artery bypass graft, DSMC, Data and Safety Monitoring Committee, FDR, false discovery rate, ICU, intensive care unit, INR, international normalized ratio, OPCAB, off-pump coronary artery bypass, POD, postoperative day

CTSNet classification: 23, 32

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Operations performed at the Summit Medical Center, Oakland, Calif.

 Disclosures: This study was funded by the Kaiser Foundation Research Institute and the Department of Medicine, Kaiser Permanente Medical Center, Oakland, Calif. No financial interest or potential conflict of interest exists for any of the authors.

 This study has been registered with the Protocol Registration System at ClinicalTrials.gov. The ClinicalTrials.gov identifier is NCT00307138.

PII: S0022-5223(09)00367-5

doi:10.1016/j.jtcvs.2009.02.035

Refers to erratum:

  • Notice of Correction

    The Journal of Thoracic and Cardiovascular Surgery March 2010 (Vol. 139, Issue 3, Page 808)

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 3 , Pages 703-711, September 2009

Article Tools