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Clinical Investigations: SURGERY |

Hetastarch and Bleeding Complications After Coronary Artery Surgery*

Jerry Avorn; Minalkumar Patel; Raisa Levin; Wolfgang C. Winkelmayer
Author and Funding Information

*From the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Correspondence to: Jerry Avorn, MD, Chief, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, 221 Longwood Ave, BLI/341, Boston, MA 02115; e-mail: javorn@rics.bwh.harvard.edu



Chest. 2003;124(4):1437-1442. doi:10.1378/chest.124.4.1437
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Study objectives: Controversy persists concerning the potential association between intraoperative use of hetastarch (ie, hydroxyethyl starch [HES]) and postoperative bleeding in patients undergoing surgery. To determine whether intraoperative HES use is associated with an increased risk of postoperative bleeding following coronary artery bypass graft (CABG) surgery.

Design: Case-control study.

Setting: A large academic medical center in the northeastern United States.

Participants: A consecutive sample of 238 patients undergoing CABG surgery.

Main outcome measures: Cases consisted of patients who had received either ≥ 3 U packed RBCs, ≥ 3 U platelets, ≥ 3 U fresh frozen plasma, or any cryoprecipitate within 72 h after undergoing a CABG procedure, or who had undergone surgical revision for bleeding. All other CABG surgery patients served as control subjects.

Results: In multivariate models that controlled for a wide variety of demographic and clinical characteristics, we found that, compared to patients who did not receive any HES during surgery, those who received 1 U intraoperative HES had more than twice the risk of a bleeding outcome (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.10 to 4.91), and those who received 2 or 3 U HES had more than four times the risk of postoperative bleeding (OR, 4.57; 95% CI, 1.74 to 12.00).

Conclusions: HES use in patients undergoing CABG surgery may be associated with a significant risk of postoperative bleeding. A double-blinded, randomized, controlled trial will be necessary to confirm this finding.


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