For over 60 years the safety of hydroxyethyl starch (HES) and its use have been debated, with many physicians arguing that the fluid has serious adverse events and is often misused. The European Medicines Agency (EMA) took the decision to increase restrictions on the use of HES in June 2018, however, some have called for a total ban and feel patient safety is at risk. Controversies around coagulation impairment and tissue storage effects were reported shortly after HES introduction into a clinical setting. Two recent letters to editor by Jon Henrik Laake and Frederico Bilotta, have highlighted the evidence to date and explored the events that have occurred in the build-up to the recent EMA decision (Bilotta et al., 2018; Laake & Møller, 2018). You can see how these events and studies have shaped current views and practices of HES therapy by clicking on the years in the interactive timeline below.
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