What are the indications for Hespan (hetastarch)?

From the Guidelines

Hespan (hetastarch) should not be used as a first-line agent for plasma volume expansion in patients at risk for acute kidney injury (AKI) or with AKI, due to the increased risk of renal impairment and mortality associated with its use 1. The indications for Hespan are limited, and its use is generally reserved for situations where crystalloids are not effective or appropriate.

• Hespan may be considered in cases of severe hypovolemia or hemorrhagic shock, where rapid volume replacement is necessary and blood products are not available or appropriate.
• The typical adult dosage is 500-1000 mL (approximately 10-20 mL/kg) administered intravenously, with a maximum daily dose of 1500 mL or 20 mL/kg.
• However, the use of Hespan is associated with significant risks, including acute kidney injury, coagulopathy, and mortality, particularly in patients with severe sepsis or AKI 1.
• Alternative volume expanders, such as crystalloids (normal saline, lactated Ringer's) or other colloids, are often preferred due to their more favorable safety profiles.
• Hespan is contraindicated in patients with severe bleeding disorders, congestive heart failure, renal failure with oliguria or anuria, and in those with hypersensitivity to the drug.
• Careful monitoring of fluid status, renal function, and coagulation parameters is essential during administration of Hespan.
• The KDIGO guidelines recommend using isotonic crystalloids rather than colloids, including Hespan, as initial management for expansion of intravascular volume in patients at risk for AKI or with AKI 1.

From the FDA Drug Label

6% Hetastarch in 0.9% Sodium Chloride Injection is indicated in the treatment of hypovolemia when plasma volume expansion is desired. The adjunctive use of 6% Hetastarch in 0.9% Sodium Chloride Injection in leukapheresis has also been shown to be safe and efficacious in improving the harvesting and increasing the yield of granulocytes by centrifugal means.

The indications for Hespan (hetastarch) are:

• Treatment of hypovolemia when plasma volume expansion is desired
• Leukapheresis to improve the harvesting and increase the yield of granulocytes by centrifugal means 2 2

From the Research

Indications for Hespan (Hetastarch)

Hespan, also known as hetastarch, is a colloid plasma expander used in various medical conditions. The indications for Hespan can be summarized as follows:

• Hypovolemic shock: Hespan is used to treat hypovolemic shock, a condition characterized by decreased blood volume, often due to bleeding or fluid loss 3, 4, 5.
• Trauma patients: Hespan can be used in trauma patients requiring emergency surgery, particularly those with penetrating trauma, to help expand blood volume and improve hemodynamics 3.
• Burn patients: Although not directly mentioned in the provided studies, burn patients may experience hypovolemia and benefit from Hespan treatment, as part of a broader approach to managing burn-induced acute kidney injury 6.
• Resuscitation: Hespan can be used as a resuscitative adjuvant in hemorrhagic shock, in combination with other treatments such as deferoxamine, to help improve liver function and overall outcomes 4.
• Volume expansion: Hespan is effective in expanding intravascular volume, particularly in cases of moderate hypovolemia, and can be used to increase blood volume and cardiac output 7.

Key Considerations

When using Hespan, it is essential to consider the following:

• Dosage and administration: The optimal dosage and administration of Hespan vary depending on the specific condition being treated and the patient's individual needs 3, 4, 7.
• Contraindications and side effects: Hespan may have contraindications and side effects, such as coagulopathy or renal dysfunction, which should be carefully monitored and managed 3, 5.
• Combination therapy: Hespan may be used in combination with other treatments, such as crystalloids, blood products, or vasopressors, to achieve optimal outcomes 3, 5.