The year 2013 began with a large systematic review and meta-analysis reporting no adverse effects or increased mortality in surgical patients receiving tetrastarches, but ended with a contrasting decision made by the European Medicines Agency (EMA) to implement restrictions of hydroxyethyl starch (HES) solutions in patients with sepsis, burns, or who were critically ill. Read more about the evidence in the year that shaped this decision and why the evidence on the pro side of the debate may not have been clear-cut as originally suggested. 

2013 Hydroxyethyl starch timeline.

The decision made resulted in legal restrictions across Europe, but support for this decision didn’t spread as universally as the EMA may have hoped for. In fact, nearly half of the experts involved went on to criticise the decision in 2014.

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