Intracranial Bleeding during Treatment with Hydroxyethyl Starch

To the Editor: Intravascular volume expansion to prevent intracranial arterial spasm is a well-established treatment for intracranial hemorrhage. 1 2 3 The use of hetastarch (hydroxyethyl starch) to expand plasma volume is now a common practice in neurosurgery. In normal volunteers, coagulation abnormalities have been associated with the administration of hetastarch, 4 , 5 and minor bleeding in neurosurgical patients receiving this agent has recently been reported. 6 We report a case of coagulopathy with ititracranial hemorrhage in a patient treated with hetastarch. A 36-year-old woman was admitted with a severe headache following a syncopal episode. CT scanning revealed a subarachnoid hemorrhage, and cerebral angiography demonstrated an . . .