Effects of intravascular volume therapy using hydroxyethyl starch (130/0.4) on post-operative bleeding and transfusion requirements in children undergoing cardiac surgery: a randomized clinical trial

Acta Anaesthesiol Scand. 2006 Jan;50(1):108-11. doi: 10.1111/j.1399-6576.2005.00881.x.


Background: Hydroxyethyl starch (HES) used for intravascular volume expansion may cause coagulation abnormalities, especially in cardiac patients. Although low molecular weight HES (130/0.4) has been developed to minimize its influence on coagulation, experience with HES (130/0.4) in children is limited. Therefore, we evaluated the effects of a HES (130/0.4) infusion on post-operative blood loss in children undergoing cardiac surgery.

Methods: Forty-two children undergoing cardiac surgery were assigned at random to receive either 10 ml/kg fresh frozen plasma (FFP group; n=21) or HES (130/0.4) (HES group; n=21) shortly after cardiopulmonary bypass termination. Activated partial thromboplastin time (aPTT) and international normalization ratio (INR) were measured. In addition, post-operative transfusion requirements and blood loss until the end of the first post-operative day were compared.

Results: INR was significantly prolonged after HES infusion in comparison to the FFP group (P<0.05). During the first 24 h after surgery, post-operative blood loss, the use of allogenic blood/blood products and aPTT were similar in all children.

Conclusions: Our study shows that the administration of a moderate dose of HES (130/0.4) in children undergoing cardiac surgery does not cause more bleeding or a higher transfusion requirement than a FFP infusion, and suggests that the administration of 10 ml/kg HES (130/0.4) is a safe alternative to plasma for intravascular volume replacement in this patient population.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Blood Transfusion*
  • Cardiac Surgical Procedures*
  • Cardiopulmonary Bypass
  • Child
  • Child, Preschool
  • Heart Defects, Congenital / surgery
  • Humans
  • Hydroxyethyl Starch Derivatives / administration & dosage*
  • Infant
  • International Normalized Ratio
  • Molecular Weight
  • Partial Thromboplastin Time
  • Plasma
  • Plasma Substitutes / administration & dosage*
  • Postoperative Care
  • Postoperative Hemorrhage / therapy*


  • Hydroxyethyl Starch Derivatives
  • Plasma Substitutes