Jt. Cope et al., INTRAOPERATIVE HETASTARCH INFUSION IMPAIRS HEMOSTASIS AFTER CARDIAC OPERATIONS, The Annals of thoracic surgery, 63(1), 1997, pp. 78-82
Background. An outbreak of excessive bleeding after cardiac operations
occurred at our institution when 5% albumin was in short supply and h
etastarch became the preferred intraoperative colloid. As hetastarch m
ay impair coagulation, we investigated the effects of its intraoperati
ve administration on post-cardiac surgical hemostasis. Methods. Indice
s of postoperative hemostasis were analyzed in 189 consecutive patient
s undergoing coronary artery bypass grafting. Three groups were compar
ed: 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 postoperativ
ely only, and a third group (n = 62) received no hetastarch. Results.
Compared with the other two groups, those patients administered hetast
arch intraoperatively exhibited significant reductions in hematocrit a
nd platelet count, a significant prolongation in the prothrombin time,
and significant increases in both blood loss and hemostatic drug requ
irement. Also identified were obvious trends toward a greater transfus
ion requirement and reexploration rate for bleeding in the latter grou
p. Conclusions. Hetastarch infusion just after weaning from cardiopulm
onary bypass produces a clinically important impairment in post-cardia
c surgical hemostasis. Intraoperative use of this agent during heart o
perations should be avoided until the safe timing of its administratio
n is clarified. (C) 1997 by The Society of Thoracic Surgeons