Hetastarch and Bleeding Complications

Excerpt

To the editor: As the consulting hematologist to a neurosurgery service, I saw two patients with coagulopathy and minor bleeding in whom hetastarch (hydroxyethyl starch) was used to expand plasma volume. These patients had previously had minor surgery without bleeding.

Patient 1: A previously healthy 27-year-old man had surgery to clip a subarachnoid hemorrhage after a posterior communicating aneurysm ruptured. His preoperative coagulation screen yielded normal values for prothrombin time (PT, 12.7 s) and partial thromboplastin time (PTT, 24 s). The patient developed abnormal coagulation variables after surgery while being given 1 to 2 L/d of hetastarch: PT, 15 s;