Document Detail


Hetastarch increases the risk of bleeding complications in patients after off-pump coronary bypass surgery: a randomized clinical trial.
MedLine Citation:
PMID:  19698859     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Hetastarch is an artificial colloid widely used intraoperatively in fluid-replacement regimens. Previous studies have found that the intraoperative administration of hetastarch may increase the risk of postoperative bleeding in patients who undergo coronary artery bypass graft surgery with cardiopulmonary bypass. Previous published reports have not examined this risk in patients who underwent coronary artery bypass grafting without cardiopulmonary bypass. METHODS: In a randomized clinical trial, 156 patients undergoing off-pump coronary artery bypass grafting were assigned to receive either 1 liter of hetastarch or 1 liter of albumin as part of intraoperative volume replacement. Sample recruitment was halted in a review per protocol by the study's Data Safety Monitoring Committee. We assessed the rate of postoperative bleeding by monitoring the number of units of blood products transfused in the first 24 postoperative hours in the intensive care unit and the hourly chest tube drainage in the first 12 postoperative hours. RESULTS: Intraoperative administration of 1 liter of hetastarch was associated with statistically significant increases in 3 measures: transfusion requirements on postoperative day 1 (red blood cells, 1.14 vs 0.40 units, P = .017; fresh-frozen plasma, 0.57 vs 0.15, P = .009; platelets, 0.35 vs 0.10, P = .013); the overall likelihood of receiving transfusion on postoperative day 1 (46.2% vs 25.6%, P = .012); and the volume of chest tube drainage in the first 12 hours postoperatively (732.0 vs 563.6 mL, P < .001). CONCLUSION: In patients undergoing off-pump coronary artery bypass, the intraoperative administration of hetastarch increases the postoperative transfusion requirement and the volume of blood drained postoperatively.
Authors:
Marketa Hecht-Dolnik; Howard Barkan; Ananse Taharka; John Loftus
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-05-27
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  138     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-24     Completed Date:  2009-09-18     Revised Date:  2010-03-04    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  703-11     Citation Subset:  AIM; IM    
Affiliation:
Kaiser Permanente Medical Center, Oakland, Calif, USA. howardbarkan@cs.com
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00307138
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Blood Loss, Surgical / mortality,  prevention & control*,  statistics & numerical data
Blood Transfusion / statistics & numerical data
Body Mass Index
Coronary Artery Bypass / adverse effects*,  mortality
Female
Hetastarch / adverse effects*
Humans
Intraoperative Care / adverse effects
Length of Stay
Likelihood Functions
Male
Middle Aged
Multivariate Analysis
Plasma Substitutes / adverse effects
Prospective Studies
Survival Rate
Chemical
Reg. No./Substance:
0/Plasma Substitutes; 9005-27-0/Hetastarch
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2010 Mar;139(3):801; author reply 801   [PMID:  20176230 ]
J Thorac Cardiovasc Surg. 2010 Mar;139(3):793-4; author reply 794-5   [PMID:  20176221 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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