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Hydroxyethyl Starch 130/0.4 and Surgical Blood Loss

Section Editor(s): Saidman, LawrenceHartog, Christiane MD; Brunkhorst, Frank MD; Reinhart, Konrad MD

doi: 10.1213/ane.0b013e31818ee38a
Letters to the Editor: Letters & Announcements
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Department of Anesthesiology and Intensive Care Medicine; Friedrich-Schiller-University; Jena, Germany; konrad.reinhart@med.uni-jena.de

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To the Editor:

The pooled analysis by Kozek-Langenecker concluding that Hydroxyethyl Starch (HES)130/0.4 leads to less surgical blood loss than HES200/0.51 requires some critical comments and caveats. Overall, the derived differences were marginal, and were not significant in the largest subgroup (cardiac surgical patients). Unbalanced addition of gelatin, which impairs coagulation,2 to the HES200/0.5 group was not considered.3 Cumulative doses were not comparable; 33.2 mL/kg of HES130/0.4 is equivalent to 66% of one daily maximum dose, but 28.2 mL/kg of HES200/0.5 amounts to 86%. Reference 4 does not include any data on blood loss or transfusion.4 At least two trials comparing blood loss or transfusion requirements between the two HES were excluded.5,6 Further evidence suggests that all HES solutions impair coagulation to a similar degree irrespective of molecular weight.7–9 Regrettably, the authors also minimize the negative effects of HES200/0.5 on kidney function and blood transfusion which were found in a recent randomized controlled trial.10 Their claim that HES was given to patients with anuria or renal replacement therapy is incorrect, no such patient was enrolled in the trial. Finally, we are concerned that one of the authors (CJ) is an employee of Fresenius Kabi-the company manufacturing Voluven (Hydroxyethyl Starch 130/0.4) and providing support for this study.

Christiane Hartog, MD

Frank Brunkhorst, MD

Konrad Reinhart, MD

Department of Anesthesiology and Intensive Care Medicine

Friedrich-Schiller-University

Jena, Germany

konrad.reinhart@med.uni-jena.de

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REFERENCES

1. Kozek-Langenecker SA, Jungheinrich C, Sauermann W, Van der Linden P. The effects of hydroxyethyl starch 130/0.4 (6%) on blood loss and use of blood products in major surgery: a pooled analysis of randomized clinical trials. Anesth Analg 2008;107:382–90
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9. Huttner I, Boldt J, Haisch G, Suttner S, Kumle B, Schulz H. Influence of different colloids on molecular markers of haemostasis and platelet function in patients undergoing major abdominal surgery. Br J Anaesth 2000;85:417–23
10. Brunkhorst FM, Englel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358:125–39
© 2009 International Anesthesia Research Society