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Effect of hetastarch on calculated blood loss during elective cesarean delivery
Abstract Number: T-53
Abstract Type: Original Research
Hetastarch (HES) is the most commonly used synthetic colloid in the obstetrical population to prevent hypotension following subarachnoid anesthesia for cesarean birth. Synthetic colloids in general have been associated with coagulopathy, increased risk of bleeding and transfusion requirements, (1). Indeed, an accumulation of evidence has revealed an acquired coagulopathy associated with HES. The mechanism remains poorly defined but it is currently thought to be secondary to an acquired fibrinogen deficiency or fibrinogen dysfunction directly caused by the use of HES (2). The aim of this study was to determine whether preload/co-load of HES to prevent spinal hypotension during cesarean birth is associated with an increased risk in bleeding when compared to crystalloid.
We conducted a retrospective study of patients who underwent elective cesarean delivery under spinal anesthesia at the university of Virginia labor and delivery ward between 2011-2014. Data from 819 patients was used. Our primary outcome (blood loss) was calculated using the following; we calculated the blood loss based on the difference in preoperative (within one day) and postoperative (first postoperative day) hematocrit difference, using a previously validated method (3). A propensity match score was used to match patients who received hetastarch (HES group) to those who did not (Control group), based on age, Gravida, Para, number of fetuses, gestational age, BMI, number of previous cesarean delivery, infant weight, duration of surgery, and amount of oxytocin used during surgery.
Using genetic matching, our matching resulted in 201 patients in HES group and 147 patients in the control group. Taking into account multiple comparisons were made, a Bonferroni-adjusted significance level of .005 was used. There where no difference in estimated blood loss (p = .208), calculated blood loss (p = .789), total intraoperative fluids intake (p = .048), urine output (p = .721), phenylephrine (p = .141), ondansetron (p = .200), ephedrine (p = .030), Apgar 1 min (p = .796), Apgar 5 min (p = .643), and length of hospital stay (p = .288).
Overall, our study revealed that there was no association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean section. Therefore, hetastarch may be safe to use in this select patient population with respect to end-organ effect such as acute kidney injury without concern for increased blood loss. This study also did not find any associated benefits with hetastarch use such as less vasopressor use, less total intravenous fluid administration, higher Apgar scores, or decreases length of hospital stay to justify the increased cost associated with hetastarch use versus crystalloid use.
1. American Thoracic Society Documents. Am J Respir Crit Care Med Vol 170. 2004.
2. Fenger-Eriksen. Journal of Thrombosis and Haemostasis, 7: 1099-1105.