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 ,Revised 30 December 2008 ,Accepted 16 February 2009.

References 

  1. Avorn J, Patel M, Levin R, Winkelmayer WC. Hetastarch and bleeding complications after coronary artery surgery. Chest. 2003;124:1437–1442
  2. London MJ, Ho JS, Triedman JK, et al. A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg. 1989;97:785–797
  3. Wilkes MM, Navickis RJ, Sibbald WJ. Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a metaanalysis of postoperative bleeding. Ann Thorac Surg. 2003;72:527–533
  4. Knutson JE, Deering JA, Hall FW, et al. Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery?. Anesth Analg. 2000;90:801–807
  5. Alexander JC. Hetastarch in perioperative volume expansion. Chest. 2003;124:1194–1196
  6. Shander A, Rijhwani T, Moskowitz D. Blood and starch in cardiac surgery. Chest. 2004;125:2369–2370
  7. Wilkes MM, Navickis RJ. Hydroxyethyl starch-induced postoperative bleeding in cardiac surgery patients: more trials needed?. Chest. 2004;126:311–312
  8. Sade RM, Stroud MR, Crawford FA, Kratz JM, Dearing JP, Bartles DM. A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1985;89:713–722
  9. Boldt J, Knothe C, Zickmann B, et al. Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass. Anesth Analg. 1993;76:1185–1190
  10. Warren BB, Durieux ME. Hydroxyethyl starch: safe or not?. Anesth Analg. 1997;84:206–212
  11. Haynes GR. Fluid management in cardiac surgery: is one hydroxyethyl starch solution safer than another?. J Cardiothorac Vasc Anesth. 2006;20:916–917
  12. Haynes GR, Havidich JE, Payne KJ. Why the Food and Drug Administration changed the warning label for hetastarch. Anesthesiology. 2004;101:560–561
  13. Boldt J. Volume therapy in cardiac surgery: are Americans different from Europeans?. J Cardiothorac Vasc Anesth. 2006;20:98–105
  14. Bunn F, Trivedi D, Ashraf S. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2008;CD001319
  15. Kozek-Langenecker SA. Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology. 2005;103:654–660
  16. Cochrane Injuries Group Albumin Reviewers . Human albumin administration in critically ill patients: Systematic review of randomized controlled trials. BMJ. 1998;317:235–240
  17. Boldt J. New light on intravascular volume replacement regimens: what did we learn from the past three years?. Anesth Analg. 2003;97:1595–1604
  18. Herwaldt LA, Swartzendruber SK, Edmond MB, et al. The epidemiology of hemorrhage related to cardiothoracic operations. Infect Control Hosp Epidemiol. 1998;19:9–16
  19. Sedrakyan A, Gondek K, Paltiel D, Elefteriades JA. Volume expansion with albumin decreases mortality after coronary artery bypass graft surgery. Chest. 2003;123:1853–1857
  20. Boldt J, Muller M, Mentges D, et al. Volume therapy in the critically ill: is there a difference?. Intensive Care Med. 1998;24:28–36
  21. Boldt J, Suttner S, Kumle B, Huttner I. Cost analysis of different volume replacement strategies in anesthesia. Infusionstherapie und Transfusionsmedizin. 2000;27:38–43
  22. Pepper J. Controversies in off-pump coronary artery surgery. Clin Med Res. 2005;3:27–33
  23. Raja SG. Pump or no pump for coronary artery bypass: current best available evidence. Tex Heart Inst J. 2005;32:489–501
  24. Lo B, Fijnheer R, Castigliego D, et al. Activation of hemostasis after coronary artery bypass grafting with or without cardiopulmonary bypass. Anesth Analg. 2004;99:634–640
  25. Ascione R, Williams S, Lloyd CT, et al. Reduced postoperative blood loss and transfusion requirement after beating-heart operations: a prospective randomized study. J Thorac Cardiovasc Surg. 2001;121:689–696
  26. Reston JT, Tregear SJ, Turkelson CM. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg. 2003;76:1510–1515
  27. Jones B, Jarvis P, Lewis JA, Ebbutt AF. Trials to assess equivalence: the importance of rigorous methods. BMJ. 1996;313:36–39Erratum in: BMJ. 1996;313:550
  28. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Statist Soc B. 1995;57:289–300
  29. Alderson P, Bunn F, Li Wan Po A, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database of Systematic Reviews. 2004;4;Art. CD001208
  30. Goodenough LT, Johnston MFM, Toy PTCY, et al. The variability of transfusion practice in coronary artery bypass surgery. JAMA. 1991;265:86–90

 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

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