Re-framing the question: Should hydroxyethyl starch be used in clinical practice?

Zarychanski, Ryan; Turgeon, Alexis F.

doi:10.1007/s12630-018-1246-4

Cited by 5 publications

(1 citation statement)

References 13 publications

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“…However, in spite of a lively scientific debate over the last two decades, the perioperative use of synthetic colloids remains a controversial issue [3][4][5][6][7]. Following two studies published in 2012 [8,9], the European Medicine Agency (EMA) and the US Food and Drug Administration (FDA) issued warnings that hydroxyethyl starch (HES) should no longer be used in critically ill patients due to a possible rise in kidney injury and mortality associated with the administration of HES [10,11].…”

Section: Introductionmentioning

confidence: 99%

Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial

Gratz

Zotti

Pausch

et al. 2021

JCM

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The use of colloids may impair hemostatic capacity. However, it remains unclear whether this also holds true when colloids are administered in a goal-directed manner. The aim of the present study was to assess the effect of goal-directed fluid management with 6% hydroxyethyl starch 130/0.4 on hemostasis compared to lactated Ringer’s solution in patients undergoing partial hepatectomy. We included 50 patients in this prospective, randomized, controlled trial. According to randomization, patients received boluses of either hydroxyethyl starch or lactated Ringer’s solution within the scope of goal-directed fluid management. Minimum perioperative FIBTEM maximum clot firmness (MCF) served as the primary outcome parameter. Secondary outcome parameters included fibrinogen levels and estimated blood loss. In the hydroxyethyl starch (HES) group the minimum FIBTEM MCF value was significantly lower (effect size −6 mm, 95% CI −10 to −3, p < 0.001) in comparison to the lactated Ringer’s solution (RL) group. These results returned to normal within 24 h. We observed no difference in plasma fibrinogen levels (RL 3.08 ± 0.37 g L−1 vs HES 2.65 ± 0.64 g L−1, p = 0.18) or the amount of blood loss between the two groups (RL 470 ± 299 mL vs HES 604 ± 351 mL, p = 0.18). We showed that goal-directed use of HES impairs fibrin polymerization in a dose-dependent manner when compared with RL. Results returned to normal on the first postoperative day without administration of procoagulant drugs and no differences in blood loss were observed.

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