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Ann Thorac Surg 2001;72:534
© 2001 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, University of Alabama at Birmingham, 1530 3rd Ave South – 2RB719, Birmingham, AL 35294-0007, USA
e-mail: wholman{at}its.uab.edu
Wilkes and associates performed a meta-analysis of randomized trials that compared the use of albumin and hydroxyethyl starch (HES) solutions in cardiac surgery. Their goal was to determine if the use of HES solutions is associated with increased postoperative blood loss. The rationale for performing this meta-analysis is the adverse effect that HES solutions have on platelet function, together with the relatively small numbers of patients included in most randomized trials of albumin versus HES solutions. The methods are described well and are a model for such studies. It appears that the use of HES solutions either preoperatively, intraoperatively, or postoperatively is associated with greater blood loss than occurs with the use of albumin solutions. This additional blood loss averaged roughly 100 mL across studies, and the prevalence of blood loss greater than 1000 mL in the first 24 postoperative hours was significantly greater in the HES group. Other endpoints such as the number of transfusions given, the duration of mechanical ventilation, and reoperation rate, were less convincingly supportive of albumin solutions.
What are the implications of this information for practicing cardiac surgeons? Is it possible to balance the risks of HES solutions in cardiac surgery with the cost savings that can be achieved by using less albumin?
These questions must be answered on an individual surgeon basis, preferably after a comparison of results (eg, average blood loss, reentry rate and transfusion utilization) against established benchmarks. The information that the authors generated by analyzing 16 independent studies of albumin versus HES solutions calls into question the routine use of HES solutions, especially in large volumes or in situations where the risk of coagulopathic bleeding is higher than normal. However, the effect of HES solutions is not so dire that they should be abandoned altogether. The decision of which solution to prescribe and how much to use depends on the balance of cost with the advantages and adverse effects for each type of solution. This balance will change in the future if new plasma expanders are synthesized which do not adversely affect platelet function, or if albumin solutions are available at lower cost.
Related Article
Ann. Thorac. Surg. 2001 72: 527-533.
This article has been cited by other articles:
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  M. M. Wilkes, R. J. Navickis, J. Avorn, and W. Winkelmayer Hydroxyethyl Starch-Induced Postoperative Bleeding in Cardiac Surgery Patients: More Trials Needed? Chest, July 1, 2004; 126(1): 311 - 312. [Full Text] [PDF]
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