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1: Ann Thorac Surg. 1997 Jan;63(1):78-82; discussion 82-3.
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Intraoperative hetastarch infusion impairs hemostasis after cardiac operations.

Cope JT, Banks D, Mauney MC, Lucktong T, Shockey KS, Kron IL, Tribble CG.

Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.

BACKGROUND: An outbreak of excessive bleeding after cardiac operations occurred at our institution when 5% albumin was in short supply and hetastarch became the preferred intraoperative colloid. As hetastarch may impair coagulation, we investigated the effects of its intraoperative administration on post-cardiac surgical hemostasis. METHODS: Indices of postoperative hemostasis were analyzed in 189 consecutive patients undergoing coronary artery bypass grafting. Three groups were compared: one group (n = 68) received a mean of 796 mL of hetastarch only in the operating room (a few minutes after cessation of cardiopulmonary bypass), another group (n = 59) received a mean of 856 mL postoperatively only, and a third group (n = 62) received no hetastarch. RESULTS: Compared with the other two groups, those patients administered hetastarch intraoperatively exhibited significant reductions in hematocrit and platelet count, a significant prolongation in the prothrombin time, and significant increases in both blood loss and hemostatic drug requirement. Also identified were obvious trends toward a greater transfusion requirement and reexploration rate for bleeding in the latter group. CONCLUSIONS: Hetastarch infusion just after weaning from cardiopulmonary bypass produces a clinically important impairment in post-cardiac surgical hemostasis. Intraoperative use of this agent during heart operations should be avoided until the safe timing of its administration is clarified.

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PMID: 8993245 [PubMed - indexed for MEDLINE]