Hetastarch and Hydroxyethyl Starch Are Not the Same

In Response: I would like to thank Dr. Huettemann for his thoughtful letter to the editor. As noted by Treib et al. (1), there is only one type of hydroxyethyl starch available in the United States, whereas several hydroxyethyl starch preparations are widely used in Europe. The results of our study should only be applied to the preparation used in the United States (Hespan®, Abbott Laboratories, North Chicago, IL; average molecular weight 450,000 daltons, substitution of 0.7) or similar European preparations, because they induce a greater degree of anticoagulation than the smaller, more easily degraded hydroxyethyl starch preparations (1). Furthermore, as the anticoagulant effects of hydroxyethyl starch may potentiate the known coagulopathic state induced by cardiopulmonary bypass and exacerbate bleeding, the results of our study can only be applied to patients undergoing cardiopulmonary bypass. Gregory A. Nuttall MD