The Annals of Thoracic Surgery, Vol 39, 422-425, Copyright © 1985 by The Society of Thoracic Surgeons
Platelet inhibitors and hydroxyethyl starch: safe and cost-effective interventions in coronary artery surgery
GL Hicks Jr, LA Jensen, LH Norsen, JR Quinn, SS Stewart and JA DeWeese
This study evaluated the cost-effectiveness and clinical safety of
utilizing hetastarch in pump prime solutions and for colloid replacement
postoperatively in conjunction with the platelet inhibitors, aspirin and
Persantine (dipyridamole). Sixty-four adult patients undergoing a coronary
artery bypass operation were divided into two groups. Group 1 (N = 32)
received only Persantine (75 mg three times a day) on the day prior to
operation. Group 2 (N = 32) received the same Persantine dose plus aspirin
(325 mg). In both groups, aspirin and Persantine were continued
postoperatively and hetastarch was used as the colloid of choice. All
patients were evaluated for blood loss, coagulation profiles, cost of blood
and colloid replacement, and clinical course. Group 2 patients demonstrated
significantly greater blood loss (p less than 0.05) but the same
postoperative coagulation profiles as Group 1. The transfusion requirement
(3.6 units versus 1.3 units) and cost basis ($252 versus $91) for patient
care were higher in Group 2. Hetastarch had no effect on blood loss and was
not associated with any adverse clinical reactions. Annual institutional
savings based on utilization of hetastarch were calculated at $33,500 to
$40,500 per 500 patients. We conclude that preoperative administration of
aspirin (325 mg) is associated with increased perioperative blood loss and
higher patient costs, two variables not demonstrable with Persantine only.
Use of hetastarch combined with postoperative platelet inhibition was
clinically safe and was a cost-effective method of colloid replacement.
