Effect of hydroxyethyl starch on bleeding after cardiopulmonary bypass: a meta-analysis of randomized trials

The effects of hydroxyethyl starch on bleeding after cardiopulmonary bypass were determined. A meta-analysis was performed of postoperative blood loss in randomized clinical trials of hydroxyethyl starch versus albumin for fluid management in adult cardiopulmonary bypass surgery. Impacts of hydroxye...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery Vol. 144; no. 1; p. 223
Main Authors: Navickis, Roberta J, Haynes, Gary R, Wilkes, Mahlon M
Format: Journal Article
Language:English
Published: United States 01.07.2012
Subjects:
Adult
Albumins - adverse effects
Blood Transfusion
Coronary Artery Bypass
Hemodynamics
Humans
Hydroxyethyl Starch Derivatives - adverse effects
Plasma Substitutes - adverse effects
Postoperative Hemorrhage - etiology
Randomized Controlled Trials as Topic
Reoperation
Risk Factors
ISSN:1097-685X, 1097-685X
Online Access:Get more information
Tags: Add Tag
No Tags, Be the first to tag this record!
Abstract The effects of hydroxyethyl starch on bleeding after cardiopulmonary bypass were determined. A meta-analysis was performed of postoperative blood loss in randomized clinical trials of hydroxyethyl starch versus albumin for fluid management in adult cardiopulmonary bypass surgery. Impacts of hydroxyethyl starch molecular weight and molar substitution were assessed. Randomized trials directly comparing different hydroxyethyl starch solutions were also included. Eighteen trials with 970 total patients were included. Compared with albumin, hydroxyethyl starch increased postoperative blood loss by 33.3% of a pooled SD (95% confidence interval, 18.2%-48.3%; P < .001). Risk of reoperation for bleeding was more than doubled by hydroxyethyl starch (relative risk, 2.24; 95% confidence interval, 1.14-4.40; P = .020). Hydroxyethyl starch increased transfusion of red blood cells by 28.4% of a pooled SD (95% confidence interval, 12.2%-44.6%; P < .001), of fresh-frozen plasma by 30.6% (95% confidence interval, 8.0%-53.1%; P = .008), and of platelets by 29.8% (95% confidence interval, 3.4%-56.2%; P = .027). None of these effects differed significantly between hydroxyethyl starch 450/0.7 and 200/0.5. Insufficient data were available for hydroxyethyl starch 130/0.4 versus albumin; however, no significant differences were detected in head-to-head comparisons of hydroxyethyl starch 130/0.4 with 200/0.5. Albumin improved hemodynamics. There were no differences in fluid balance, ventilator time, intensive care unit stay, or mortality. Hydroxyethyl starch increased blood loss, reoperation for bleeding, and blood product transfusion after cardiopulmonary bypass. There was no evidence that these risks could be mitigated by lower molecular weight and substitution.
AbstractList The effects of hydroxyethyl starch on bleeding after cardiopulmonary bypass were determined.OBJECTIVEThe effects of hydroxyethyl starch on bleeding after cardiopulmonary bypass were determined.A meta-analysis was performed of postoperative blood loss in randomized clinical trials of hydroxyethyl starch versus albumin for fluid management in adult cardiopulmonary bypass surgery. Impacts of hydroxyethyl starch molecular weight and molar substitution were assessed. Randomized trials directly comparing different hydroxyethyl starch solutions were also included.METHODSA meta-analysis was performed of postoperative blood loss in randomized clinical trials of hydroxyethyl starch versus albumin for fluid management in adult cardiopulmonary bypass surgery. Impacts of hydroxyethyl starch molecular weight and molar substitution were assessed. Randomized trials directly comparing different hydroxyethyl starch solutions were also included.Eighteen trials with 970 total patients were included. Compared with albumin, hydroxyethyl starch increased postoperative blood loss by 33.3% of a pooled SD (95% confidence interval, 18.2%-48.3%; P < .001). Risk of reoperation for bleeding was more than doubled by hydroxyethyl starch (relative risk, 2.24; 95% confidence interval, 1.14-4.40; P = .020). Hydroxyethyl starch increased transfusion of red blood cells by 28.4% of a pooled SD (95% confidence interval, 12.2%-44.6%; P < .001), of fresh-frozen plasma by 30.6% (95% confidence interval, 8.0%-53.1%; P = .008), and of platelets by 29.8% (95% confidence interval, 3.4%-56.2%; P = .027). None of these effects differed significantly between hydroxyethyl starch 450/0.7 and 200/0.5. Insufficient data were available for hydroxyethyl starch 130/0.4 versus albumin; however, no significant differences were detected in head-to-head comparisons of hydroxyethyl starch 130/0.4 with 200/0.5. Albumin improved hemodynamics. There were no differences in fluid balance, ventilator time, intensive care unit stay, or mortality.RESULTSEighteen trials with 970 total patients were included. Compared with albumin, hydroxyethyl starch increased postoperative blood loss by 33.3% of a pooled SD (95% confidence interval, 18.2%-48.3%; P < .001). Risk of reoperation for bleeding was more than doubled by hydroxyethyl starch (relative risk, 2.24; 95% confidence interval, 1.14-4.40; P = .020). Hydroxyethyl starch increased transfusion of red blood cells by 28.4% of a pooled SD (95% confidence interval, 12.2%-44.6%; P < .001), of fresh-frozen plasma by 30.6% (95% confidence interval, 8.0%-53.1%; P = .008), and of platelets by 29.8% (95% confidence interval, 3.4%-56.2%; P = .027). None of these effects differed significantly between hydroxyethyl starch 450/0.7 and 200/0.5. Insufficient data were available for hydroxyethyl starch 130/0.4 versus albumin; however, no significant differences were detected in head-to-head comparisons of hydroxyethyl starch 130/0.4 with 200/0.5. Albumin improved hemodynamics. There were no differences in fluid balance, ventilator time, intensive care unit stay, or mortality.Hydroxyethyl starch increased blood loss, reoperation for bleeding, and blood product transfusion after cardiopulmonary bypass. There was no evidence that these risks could be mitigated by lower molecular weight and substitution.CONCLUSIONSHydroxyethyl starch increased blood loss, reoperation for bleeding, and blood product transfusion after cardiopulmonary bypass. There was no evidence that these risks could be mitigated by lower molecular weight and substitution.
The effects of hydroxyethyl starch on bleeding after cardiopulmonary bypass were determined. A meta-analysis was performed of postoperative blood loss in randomized clinical trials of hydroxyethyl starch versus albumin for fluid management in adult cardiopulmonary bypass surgery. Impacts of hydroxyethyl starch molecular weight and molar substitution were assessed. Randomized trials directly comparing different hydroxyethyl starch solutions were also included. Eighteen trials with 970 total patients were included. Compared with albumin, hydroxyethyl starch increased postoperative blood loss by 33.3% of a pooled SD (95% confidence interval, 18.2%-48.3%; P < .001). Risk of reoperation for bleeding was more than doubled by hydroxyethyl starch (relative risk, 2.24; 95% confidence interval, 1.14-4.40; P = .020). Hydroxyethyl starch increased transfusion of red blood cells by 28.4% of a pooled SD (95% confidence interval, 12.2%-44.6%; P < .001), of fresh-frozen plasma by 30.6% (95% confidence interval, 8.0%-53.1%; P = .008), and of platelets by 29.8% (95% confidence interval, 3.4%-56.2%; P = .027). None of these effects differed significantly between hydroxyethyl starch 450/0.7 and 200/0.5. Insufficient data were available for hydroxyethyl starch 130/0.4 versus albumin; however, no significant differences were detected in head-to-head comparisons of hydroxyethyl starch 130/0.4 with 200/0.5. Albumin improved hemodynamics. There were no differences in fluid balance, ventilator time, intensive care unit stay, or mortality. Hydroxyethyl starch increased blood loss, reoperation for bleeding, and blood product transfusion after cardiopulmonary bypass. There was no evidence that these risks could be mitigated by lower molecular weight and substitution.
Author Navickis, Roberta J
Wilkes, Mahlon M
Haynes, Gary R
Author_xml – sequence: 1
  givenname: Roberta J
  surname: Navickis
  fullname: Navickis, Roberta J
  email: rnavickis@hygeiaassociates.com
  organization: Hygeia Associates, Grass Valley, CA 95949, USA. rnavickis@hygeiaassociates.com
– sequence: 2
  givenname: Gary R
  surname: Haynes
  fullname: Haynes, Gary R
– sequence: 3
  givenname: Mahlon M
  surname: Wilkes
  fullname: Wilkes, Mahlon M
BackLink https://www.ncbi.nlm.nih.gov/pubmed/22578894$$D View this record in MEDLINE/PubMed
BookMark eNpNkEtLAzEUhYNU7EN_gSBZupkxN-1kJu6k1AcU3Ci4K3nc2Ckzk5pkxPHXW1HB1TmLjw_OmZJR5zsk5BxYDgzE1S7fJfMec86A52yRMyaPyASYLDNRFS-jf31MpjHuGGMlA3lCxpwXZVXJxYQ0K-fQJOod3Q42-I8B03ZoaEwqmC31HdUNoq27V6pcwkCNCrb2-75pfafCQPWwVzFeU0VbTCpTnWqGWMdvYVCd9W39iZamUKsmnpJjdwg8-80Zeb5dPS3vs_Xj3cPyZp0ZwcqUAYAwQpmFmJu5cZVGwe3CGVMZnDsHrpC6kqoCYctCaa1Aai0BAZguKrR8Ri5_vPvg33qMadPW0WDTqA59HzfAOPBCFnNxQC9-0V63aDf7ULeHWZu_h_gXJOJuxQ
CitedBy_id crossref_primary_10_1016_j_bjane_2023_07_004
crossref_primary_10_1053_j_jvca_2017_04_017
crossref_primary_10_1053_j_jvca_2017_12_012
crossref_primary_10_1159_000446043
crossref_primary_10_1213_ANE_0000000000000186
crossref_primary_10_1016_j_bja_2024_07_038
crossref_primary_10_1038_s41598_023_35999_4
crossref_primary_10_1053_j_jvca_2015_11_007
crossref_primary_10_1097_EJA_0000000000001151
crossref_primary_10_1097_ALN_0b013e31829ff2f4
crossref_primary_10_1053_j_jvca_2016_07_028
crossref_primary_10_1007_s00101_013_2220_8
crossref_primary_10_1111_anae_14994
crossref_primary_10_1007_s40140_014_0067_4
crossref_primary_10_1097_SLA_0b013e31827ba25d
crossref_primary_10_1016_j_jtcvs_2012_08_075
crossref_primary_10_3109_00365513_2014_891259
crossref_primary_10_1007_s00134_016_4275_x
crossref_primary_10_1111_voxs_12252
crossref_primary_10_1097_SLA_0b013e31826b8636
crossref_primary_10_1177_02676591231193626
crossref_primary_10_1016_j_athoracsur_2021_03_033
crossref_primary_10_1016_j_bja_2023_11_009
crossref_primary_10_1016_j_jss_2012_09_024
crossref_primary_10_1038_s41598_021_89889_8
crossref_primary_10_1111_vec_12283
crossref_primary_10_3109_00365513_2012_762114
crossref_primary_10_1111_trf_13795
crossref_primary_10_1080_03007995_2016_1261819
crossref_primary_10_1007_s11748_019_01091_w
crossref_primary_10_1097_MD_0000000000014383
crossref_primary_10_1186_s13054_014_0656_0
crossref_primary_10_2460_ajvr_74_8_1133
crossref_primary_10_1016_j_jtcvs_2019_12_126
crossref_primary_10_4103_ija_IJA_398_19
crossref_primary_10_1177_1089253214535667
crossref_primary_10_1097_MD_0000000000002720
crossref_primary_10_1177_02676591231222135
crossref_primary_10_1097_MD_0000000000006801
crossref_primary_10_1213_ANE_0000000000004916
crossref_primary_10_1080_08989621_2018_1450143
crossref_primary_10_1111_aas_13345
crossref_primary_10_1186_cc12531
crossref_primary_10_1097_CM9_0000000000002709
crossref_primary_10_3390_cimb47050303
crossref_primary_10_1097_TA_0000000000001772
crossref_primary_10_1007_s12630_012_9800_y
crossref_primary_10_3390_medicina61030495
crossref_primary_10_1111_trf_12892
crossref_primary_10_1001_jama_2022_10113
crossref_primary_10_1097_MD_0000000000032958
crossref_primary_10_1038_s41598_018_30053_0
crossref_primary_10_1186_s13063_020_4160_3
crossref_primary_10_1097_ASA_0000000000000007
crossref_primary_10_1111_vec_12928
crossref_primary_10_1007_s12630_023_02652_7
crossref_primary_10_1097_EJA_0000000000000447
crossref_primary_10_1053_j_jvca_2017_05_041
crossref_primary_10_1093_bja_aeu301
crossref_primary_10_1097_CM9_0000000000001661
crossref_primary_10_1016_j_carbpol_2013_03_033
crossref_primary_10_1111_vec_12208
crossref_primary_10_1186_s13054_015_0907_8
crossref_primary_10_1007_s00134_013_3167_6
crossref_primary_10_1097_MCC_0b013e3283632de6
crossref_primary_10_1016_j_athoracsur_2020_03_031
crossref_primary_10_1097_MD_0000000000004498
crossref_primary_10_1186_2052_0492_2_23
crossref_primary_10_1111_aas_13954
crossref_primary_10_1007_s12630_018_1245_5
crossref_primary_10_1186_s40545_016_0090_6
crossref_primary_10_1016_j_jtcvs_2012_09_048
crossref_primary_10_1016_j_tacc_2014_04_005
crossref_primary_10_1053_j_jvca_2015_12_025
crossref_primary_10_1080_17512433_2018_1412827
crossref_primary_10_1055_a_1861_0043
crossref_primary_10_1111_trf_12522
crossref_primary_10_23736_S0021_9509_22_12339_6
crossref_primary_10_1053_j_jvca_2021_03_011
crossref_primary_10_1093_bja_aet348
crossref_primary_10_5812_aapm_30326
crossref_primary_10_1007_s12257_022_0104_y
crossref_primary_10_1177_0897190013504960
crossref_primary_10_1053_j_jvca_2017_08_013
crossref_primary_10_1111_aas_13120
crossref_primary_10_1007_s00134_013_3111_9
crossref_primary_10_1053_j_jvca_2014_06_002
crossref_primary_10_3390_jcm12185919
crossref_primary_10_1093_icvts_ivac127
crossref_primary_10_1111_vec_12854
crossref_primary_10_1186_2193_1801_2_314
ContentType Journal Article
Copyright Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Copyright_xml – notice: Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
DBID CGR
CUY
CVF
ECM
EIF
NPM
7X8
DOI 10.1016/j.jtcvs.2012.04.009
DatabaseName Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
MEDLINE - Academic
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
MEDLINE - Academic
DatabaseTitleList MEDLINE - Academic
MEDLINE
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: 7X8
  name: MEDLINE - Academic
  url: https://search.proquest.com/medline
  sourceTypes: Aggregation Database
DeliveryMethod no_fulltext_linktorsrc
EISSN 1097-685X
ExternalDocumentID 22578894
Genre Research Support, Non-U.S. Gov't
Meta-Analysis
Journal Article
GroupedDBID ---
--K
.1-
.55
.FO
.GJ
.XZ
0R~
18M
1B1
1CY
1KJ
1P~
1~5
354
3O-
4.4
457
4G.
53G
5GY
5RE
5VS
7-5
AAEDT
AAEDW
AAEJM
AAFWJ
AALRI
AAQFI
AAQQT
AAQXK
AAXUO
AAYWO
ABCQX
ABJNI
ABLJU
ABMAC
ABOCM
ABPPZ
ABWVN
ACGFO
ACRPL
ACVFH
ADBBV
ADCNI
ADMUD
ADNMO
ADVLN
AENEX
AEUPX
AEVXI
AFFNX
AFJKZ
AFPUW
AFRHN
AFTJW
AGCQF
AGQPQ
AI.
AIGII
AITUG
AJJEV
AJUYK
AKBMS
AKRWK
AKYEP
ALMA_UNASSIGNED_HOLDINGS
AMRAJ
APXCP
ASPBG
AVWKF
AZFZN
BAWUL
BELOY
C45
C5W
CAG
CGR
COF
CS3
CUY
CVF
DIK
DU5
EBS
ECM
EFJIC
EFKBS
EIF
EJD
F5P
FDB
FEDTE
FGOYB
GBLVA
HVGLF
HZ~
IH2
IHE
J1W
J5H
K-O
KOM
L7B
M41
MO0
NPM
NQ-
O9-
OA-
OBH
OHH
OK1
OL.
OVD
P2P
R2-
RIG
ROL
RPZ
SEL
SES
SEW
SJN
SSZ
TEORI
TR2
TWZ
UDS
UNMZH
UV1
VH1
VVN
W8F
WH7
X7M
XH2
YFH
Z5R
ZGI
ZXP
ZY1
~S-
7X8
ID FETCH-LOGICAL-c607t-1116c6ac463c3cf8be62d4fcc8ce3ff1f59b89a816d75abba19bb91e110b58ed2
IEDL.DBID 7X8
ISICitedReferencesCount 106
ISICitedReferencesURI http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000305412200037&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
ISSN 1097-685X
IngestDate Sun Sep 28 08:53:29 EDT 2025
Mon Jul 21 05:54:04 EDT 2025
IsDoiOpenAccess false
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 1
Language English
License Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c607t-1116c6ac463c3cf8be62d4fcc8ce3ff1f59b89a816d75abba19bb91e110b58ed2
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
OpenAccessLink http://www.jtcvs.org/article/S0022522312004643/pdf
PMID 22578894
PQID 1021259536
PQPubID 23479
ParticipantIDs proquest_miscellaneous_1021259536
pubmed_primary_22578894
PublicationCentury 2000
PublicationDate 2012-07-01
PublicationDateYYYYMMDD 2012-07-01
PublicationDate_xml – month: 07
  year: 2012
  text: 2012-07-01
  day: 01
PublicationDecade 2010
PublicationPlace United States
PublicationPlace_xml – name: United States
PublicationTitle The Journal of thoracic and cardiovascular surgery
PublicationTitleAlternate J Thorac Cardiovasc Surg
PublicationYear 2012
References 23244264 - J Thorac Cardiovasc Surg. 2013 Jan;145(1):310-1
23244263 - J Thorac Cardiovasc Surg. 2013 Jan;145(1):309-10
References_xml – reference: 23244264 - J Thorac Cardiovasc Surg. 2013 Jan;145(1):310-1
– reference: 23244263 - J Thorac Cardiovasc Surg. 2013 Jan;145(1):309-10
SSID ssj0007019
Score 2.4314864
SecondaryResourceType review_article
Snippet The effects of hydroxyethyl starch on bleeding after cardiopulmonary bypass were determined. A meta-analysis was performed of postoperative blood loss in...
The effects of hydroxyethyl starch on bleeding after cardiopulmonary bypass were determined.OBJECTIVEThe effects of hydroxyethyl starch on bleeding after...
SourceID proquest
pubmed
SourceType Aggregation Database
Index Database
StartPage 223
SubjectTerms Adult
Albumins - adverse effects
Blood Transfusion
Coronary Artery Bypass
Hemodynamics
Humans
Hydroxyethyl Starch Derivatives - adverse effects
Plasma Substitutes - adverse effects
Postoperative Hemorrhage - etiology
Randomized Controlled Trials as Topic
Reoperation
Risk Factors
Title Effect of hydroxyethyl starch on bleeding after cardiopulmonary bypass: a meta-analysis of randomized trials
URI https://www.ncbi.nlm.nih.gov/pubmed/22578894
https://www.proquest.com/docview/1021259536
Volume 144
WOSCitedRecordID wos000305412200037&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
hasFullText
inHoldings 1
isFullTextHit
isPrint
link http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1LS8NAEF7UevDiA1_1xQpeF5tks9n1IiIWD1p6UMgt7BMraRKbtFB_vbublN5E8JJbhmRnMvMxM_k-AG40DY2RiUSCJQOEVcjtNxcrFGGtlGODxLH_UfglGY1omrJx13Cru7XKVU70iVqV0vXIb50EtYXqcUTuqy_kVKPcdLWT0NgEvchCGRfVSbpmC3dU437ayRJEaJyuWIf8ftdnIxeOr9s1Ax2D9i8Y09ea4d5_n3If7HYoEz60YXEANnRxCPKWqRiWBn4slVtf0dZLObT40AY7LAso8raWQa8cDqXfVa3mubXKZ0solpWF2neQw6luOOIdn4kzaCueKqeTb62g1wGpj8D78Ont8Rl1YgtIkkHSIJvziCRcYhLJSBoqNAkVNlJSqSNjAhMzQRmnAVFJzIXgAROCBdrCBxFTrcJjsFWUhT4FENOQKadoIzjGQgoqSGik5oRoaz5RfXC9OrzMBrObUPBCl_M6Wx9fH5y0HsiqlnUjC11yoQyf_eHuc7DjHNuu1V6AnrHvrS_Btlw0k3p25aPEXkfj1x8ma8r3
linkProvider ProQuest
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Effect+of+hydroxyethyl+starch+on+bleeding+after+cardiopulmonary+bypass%3A+a+meta-analysis+of+randomized+trials&rft.jtitle=The+Journal+of+thoracic+and+cardiovascular+surgery&rft.au=Navickis%2C+Roberta+J&rft.au=Haynes%2C+Gary+R&rft.au=Wilkes%2C+Mahlon+M&rft.date=2012-07-01&rft.issn=1097-685X&rft.eissn=1097-685X&rft.volume=144&rft.issue=1&rft.spage=223&rft_id=info:doi/10.1016%2Fj.jtcvs.2012.04.009&rft.externalDBID=NO_FULL_TEXT
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1097-685X&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1097-685X&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1097-685X&client=summon