Hydroxyethyl Starch

Comment This is a nicely performed study comparing tests of coagulation in patients receiving hydroxyethyl starch (HES) or plasma protein fraction (PPF). When used postoperatively in moderate amounts (500 to 1,500 ml), HES did not alter clotting or cause apparent side effects, and the authors conclude that HES is a useful alternative to PPF when volume expansion is needed. This study does not discuss the merits of using either of these solutions over other available plasma expanders. Albumin is free of some of the trace proteins which may cause occasional adverse reactions seen with PPF, and isotonic crystalloid solutions are less expensive if cost is the major concern. HES has also been reported to cause occasional allergic reactions and can result in bleeding problems if large amounts (usually more than 2,000 ml in an adult) are administered. In addition, the persistence of HES in the vascular and reticuloendothelial systems has raised at least theoretical concerns, particularly in children. Despite this report, I fail to see why either HES or PPF should be used instead of other commercially available solutions. Mark A. Rockoff, M.D.