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Hetastarch and bleeding complications after coronary artery surgery
Jerry Avorn1, Minalkumar Patel, Raisa Levin
1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. javorn@rics.bwh.harvard.edu
Chest
|October 14, 2003
Summary
Intraoperative use of hydroxyethyl starch (HES) in coronary artery bypass graft (CABG) surgery significantly increases the risk of postoperative bleeding. Higher HES doses correlated with a greater likelihood of bleeding complications.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Cardiovascular Surgery
- Pharmacology
Background:
- Controversy exists regarding the association between intraoperative hydroxyethyl starch (HES) administration and postoperative bleeding.
- Coronary artery bypass graft (CABG) surgery is a complex procedure where fluid management is critical.
Purpose of the Study:
- To investigate the potential link between intraoperative HES use and increased postoperative bleeding in patients undergoing CABG surgery.
- To quantify the risk of bleeding associated with different doses of HES during CABG procedures.
Main Methods:
- A case-control study was conducted at a major academic medical center.
- 238 patients undergoing CABG surgery were analyzed.
- Cases were defined by the need for blood products or surgical revision for bleeding within 72 hours post-CABG.
Main Results:
- Intraoperative HES use was associated with a significantly higher risk of postoperative bleeding.
- Patients receiving 1 unit of HES had more than double the risk of bleeding (OR, 2.32).
- Those receiving 2 or 3 units of HES exhibited over four times the risk of bleeding (OR, 4.57).
Conclusions:
- Intraoperative hydroxyethyl starch (HES) administration may increase the risk of postoperative bleeding in CABG patients.
- Further confirmation through a double-blinded, randomized controlled trial is warranted to validate these findings.