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Abstract
Conflicting results have been reported concerning the effect of the synthetic vasopressin
analog desmopressin acetate (DDAVP) on perioperative bleeding and homologous blood
requirements in cardiac surgery. Because patients preoperatively treated with platelet-inhibiting
drugs are at increased risk of perioperative bleeding, the blood-saving effect of
DDAVP was investigated in 40 male patients undergoing primary myocardial revascularization.
All patients had taken aspirin within the last 5 days prior to surgery. In a doubleblind,
randomized trial, the effects of DDAVP (0.3 μg/kg of body weight) were compared to
those of saline placebo on postoperative blood loss and the need to replace blood
products. To evaluate the drug's influence on the coagulation and fibrinolytic systems,
von Willebrand factor (vWF), the activities of tissue plasminogen activator (tPA)
and plasminogen activator inhibitor (PAI 1), and the split products of cross-linked
fibrin (D-dimers) were investigated. The total homologous blood requirement was significantly
lower in DDAVP recipients (median 2, range, 0 to 5 U) compared to placebo (median
3.5, range, 0 to 8 U; P < 0.05). Although at all points of measurement (intraoperative and postoperative)
transfusion requirement was less in the DDAVP group, hematocrit values of these patients
always exceeded those of the placebo group, this difference being significant at the
end of the operation. Because no difference in postoperative blood loss was found,
the markedly reduced transfusion requirement of the DDAVP-treated patients is explained
either by reduced intraoperative bleeding or by a reduced hematocrit of the chest-tube
blood. Four hours postoperatively, vWF was significantly increased in the DDAVP group
(147 ± 29% v 104 ± 52%; P < 0.05). No effect on fibrinolytic activity, ie, increase of tPA-activity or D-dimers,
or decrease of PAI 1-activity was noted. After DDAVP administration, bleeding time
was 283 ± 108 seconds in DDAVP recipients versus 341 ± 169 seconds in the control
group (NS). Six DDAVP-treated patients showed a significant drop of mean arterial
pressure after drug administration. No significant difference in urine output was
found. The current study provides some evidence that there is a subgroup of cardiac
surgical patients who may benefit from DDAVP treatment postbypass. Homologous blood
requirement was significantly reduced in patients treated with aspirin within 5 days
prior to surgery. However, because DDAVP has not been shown to be uniformly effective
and the drug is not free of hemodynamic side effects, its use should be restricted
to patients with impaired platelet function.
Keywords
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© 1993 Published by Elsevier Inc.
