INTRAOPERATIVE HETASTARCH INFUSION IMPAIRS HEMOSTASIS AFTER CARDIAC OPERATIONS

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