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A Triple-Blinded Randomized Trial Comparing the Hemostatic Effects of Large-Dose 10% Hydroxyethyl Starch 264/0.45 Versus 5% Albumin During Major Reconstructive Surgery.
Arellano, Ramiro MD, MSc, FRCPC; Gan, Bing Siang MD, PhD, FRCSC, FACS; Salpeter, Mary Jane RN; Yeo, Erik MD, PhD, FRCPC; McCluskey, Stuart MD, PhD, FRCPC; Pinto, Ruxandra PhD; Irish, Jonathan MD, MSc, FRCSC; Ross, Douglas C. MD, FRCSC; Doyle, D John MD, PhD, FRCPC; Parkin, John MD, FRCPC; Brown, Dale MD, FRCSC; Rotstein, Lorne MD, FRCSC, FACS; Witterick, Ian MD, FRCSC; Matthews, Wayne MD, FRCSC; Yoo, John MD, FRCSC; Neligan, Peter C. MD, FRCSC, FACS; Gullane, Pat MD, FRCSC, FACS; Lampe, Howard MD, FRCSC
[Article] Anesthesia & Analgesia. 100(6):1846-1853, June 2005.

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In Canada, hydroxyethyl starch 264/0.45 (HES 264/0.45; molar weight 264 kDa, molar substitution 0.45) has largely replaced albumin as the colloidal fluid of choice for perioperative intravascular volume expansion. The maximum recommended dose of HES 264/0.45 is 28 mL/kg; however, there are no clinical data supporting this limit. In this study we compared the hemostatic effects of HES 264/0.45 versus 5% albumin in doses up to 45 mL/kg over 24 h during major reconstructive head and neck surgery. Fifty patients were randomized to receive HES 264/0.45 or 5% human albumin from the induction of anesthesia until 24 h thereafter. Both albumin and HES 264/0.45 effectively maintained physiologic variables in the perioperative and postoperative periods. The partial thromboplastin time and international normalized ratio were significantly increased in the HES 264/0.45 group compared with the albumin group after infusion of 30 mL/kg and 45 mL/kg (P < 0.05). Factor VIII activity and von Willebrand factor level were significantly reduced in the HES 264/0.45 group compared with the albumin group after infusion of 15 mL/kg, 30 mL/kg, and 45 mL/kg (P < 0.05). Significantly more subjects in the HES 264/0.45 group received allogeneic red blood cell transfusions (P < 0.02). We conclude that HES 264/0.45 infusions >30 mL/kg over 24 h impair coagulation to a greater extent than albumin, possibly leading to more allogeneic transfusions.