COAGULOPATHY WITH THE USE OF HETASTARCH IN THE TREATMENT OF VASOSPASM

The use of colloid agents to achieve hypervolemia in the prevention an d treatment of postsubarachnoid hemorrhage (post-SAH) vasospasm is inc luded in the standard of care at many institutions. Risk profiles are necessary to ensure appropriate use of these agents. In a series of 85 patients with recent aneurysmal SAH, 26 developed clinical symptoms o f vasospasm. Fourteen of the 26 were treated with hetastarch for volum e expansion while the other 12 received plasma protein fraction (PPF). Clinically significant bleeding pathologies were noted in six patient s who received hetastarch as a continuous intravenous infusion. Hetast arch increased partial thromboplastin time from a mean of 23.9 seconds to a mean of 33.1 seconds (p < 0.001) in all patients who received in fusions of this agent, while no effect was noted in the 12 patients wh o received PPF infusions. No other coagulation parameters were altered . This study shows an increase in coagulopathy with the use of hetasta rch as compared with the use of PPF for the treatment of postaneurysma l vasospasm.