Ann Thorac Surg 1997;63:82-83
© 1997 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
James T. Diehl, MD
Section of Cardiothoracic Surgery Pennsylvania Hospital 301 S 8th St Philadelphia, PA 19106
See also page 78.
The increasing morbidity associated with transfusion of banked blood and our prevailing fervor for cost containment has led to a dramatic increase in the use of artificial plasma expanders in cardiac operations. For more than a decade, hydroxyethyl starch has provided a clinically safe and inexpensive alternative to blood and albumin for postoperative colloid volume expansion. There has always been concern over potential permutations in coagulation profiles, abnormalities in platelet function, and consequent increased risk of postoperative bleeding with the use of hydoxyethyl starch. There are studies that demonstrate coagulation abnormalities and increased postoperative blood loss associated with administration of greater than 20 mg/kg (about 1,500 mL) of hydroxyethyl starch. These results are thought to be secondary to dilution of blood components. Recent data suggest that lower molecular weight starch alternatives may be even safer with respect to potential coagulation irregularities associated with their use. Despite these concerns, hydroxyethyl starch has been extensively used as a postoperative volume expander in cardiac operations and is an effective alternative to blood products and albumin.
Data regarding the effects of starch substitutes on coagulation and postoperative blood loss when used intraoperatively or as a pump prime are not as extensive, and conclusions regarding their safety in this area are more difficult to draw. Doctor Cope and colleagues present data that compare a group of patients administered hydoxyethyl starch intraoperatively with groups given no starch and given starch only as a postoperative volume expander. Their data demonstrate increased blood loss in the group that received intraoperative hydroxyethyl starch when compared with the other two groups. As Cope and colleagues point out, this study is limited by the fact that it is a retrospective analysis. The implication that intraoperative administration of starch substitutes produces a clinically significant hemostatic defect after postoperative use does bear careful consideration. Doctor Cope and colleagues ask an important question concerning the safety of these widely used blood substitutes. This question should be further addressed in a controlled, prospective, randomized fashion. Only in this manner can the risks and benefits of the use of starch substitutes as volume expanders in cardiac operations be properly evaluated.
Related Article
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Intraoperative Hetastarch Infusion Impairs Hemostasis After Cardiac Operations
- Jeffrey T. Cope, David Banks, Michael C. Mauney, Tananchai Lucktong, Kimberly S. Shockey, Irving L. Kron, and Curtis G. Tribble
Ann. Thorac. Surg. 1997 63: 78-83.
[Abstract]
[Full Text]
