Desmopressin after cardiac surgery in bleeding patients. A multicenter randomized trial

Bignami, Elena; Cattaneo, Marco; Crescenzi, Giuseppe; Ranucci, Marco; Guarracino, Fabio; Cariello, Claudia; Baldassarri, Rubia; Isgrò, Giuseppe; Baryshnikova, Ekaterina; Fano, Greta; Franco, Annalisa; Gerli, Chiara; Crivellari, Martina; Zangrillo, Alberto; Landoni, Giovanni

doi:10.1111/aas.12740

Cited by 18 publications

(72 citation statements)

References 22 publications

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“…The number needed to treat to prevent one patient requiring re‐operation because of bleeding was 17. The sensitivity analyses supported the results of the main analysis (pOR, 0.48; 95% CI, 0.17–1.34; I 2 = 37%,; 292 participants; four trials) . The GRADE quality of evidence was judged to be moderate (Table ).…”

Section: Resultssupporting

confidence: 52%

“…The effect was similar for the subgroup of participants with platelet dysfunction as a result of antiplatelet agents (RR, 0.82; 95% CI, 0.61–1.10; I 2 = 32%; 229 participants; four trials) , but was smaller for those with platelet dysfunction as a result of CPB (RR, 0.92; 95% CI, 0.58–1.46; 29 participants; one trial) . There was no evidence of heterogeneity between the subgroups: I 2 = 0%.…”

Section: Resultsmentioning

confidence: 86%

“…This outcome was reported in six trials . The risk of re‐operation because of bleeding was lower for participants treated with desmopressin compared with participants treated with placebo (pOR, 0.39; 95% CI, 0.18–0.84; I 2 = 0%; 413 participants; six trials; Fig.…”

Section: Resultsmentioning

confidence: 89%

“…Although all surgical procedures regardless of specialty were potentially eligible, all 10 relevant trials were in the setting of cardiac surgery. Six trials included participants undergoing coronary artery bypass grafting (CABG) [25][26][27][28][29][30], one trial included aortic valve replacements [31] and three trials included a combination of CABG and valve replacements [24,32,33]. Nine trials included only elective surgery [24][25][26][28][29][30][31][32][33] and one trial included only emergency cases [27].…”

Section: Trial Characteristicsmentioning

confidence: 99%

“…Six trials included participants undergoing coronary artery bypass grafting (CABG) [25][26][27][28][29][30], one trial included aortic valve replacements [31] and three trials included a combination of CABG and valve replacements [24,32,33]. Nine trials included only elective surgery [24][25][26][28][29][30][31][32][33] and one trial included only emergency cases [27]. Platelet dysfunction was a result of antiplatelet agents in six trials: single-agent aspirin in four trials [25,26,29,30], dual antiplatelet therapy in one trial [27] and a combination of single-agent aspirin and dual antiplatelet therapy in one trial [24].…”

Section: Trial Characteristicsmentioning

confidence: 99%

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Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta‐analysis of randomized controlled trials

Desborough

Oakland

Landoni

et al. 2017

Journal of Thrombosis and Haemostasis

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104

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Background Platelet dysfunction, including that caused by antiplatelet agents, increases the risk of perioperative bleeding. The optimal management of patients with platelet dysfunction undergoing surgery is unclear. Objectives To assess whether desmopressin reduces perioperative allogeneic red cell transfusion and bleeding in patients with platelet dysfunction. Patients/Methods We searched for randomized controlled trials in The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, the Transfusion Evidence Library and the ISI Web of Science to 7th July 2016. Data were pooled using mean difference (MD), relative risks or Peto odds ratios (pOR) using a random-effects model. Results Ten trials with 596 participants were identified, all in the setting of cardiac surgery. Platelet dysfunction was due to antiplatelet agents in six trials and cardiopulmonary bypass in four trials. Patients treated with desmopressin were transfused with fewer red cells (MD, -0.65 units; 95% Confidence Interval [CI], -1.16 to -0.13 units), lost less blood (MD, -253.93 mL; 95% CI, -408.01 to -99.85 mL) and had a lower risk of re-operation due to bleeding (pOR, 0.39; 95% CI, 0.18-0.84). The GRADE quality of evidence was very low to moderate, suggesting considerable uncertainty over the results Conclusions Desmopressin may be a useful agent to reduce bleeding and transfusion requirements for people with platelet dysfunction or with a history of recent antiplatelet drug administration undergoing cardiac surgery.

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Section: Resultssupporting

confidence: 52%

Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 89%

Section: Trial Characteristicsmentioning

confidence: 99%

Section: Trial Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta‐analysis of randomized controlled trials

Desborough

Oakland

Landoni

et al. 2017

Journal of Thrombosis and Haemostasis

Self Cite

104

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Desmopressin use for minimising perioperative blood transfusion

Desborough

Oakland

Brierley

et al. 2017

Cochrane Database of Systematic Reviews

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Background Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. Objectives To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (2017, issue 3) in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the Transfusion Evidence Library (from 1980), and ongoing trial databases (all searches to 3 April 2017). Selection criteria We included randomised controlled trials comparing DDAVP to placebo or an active comparator (e.g. tranexamic acid, aprotinin) before, during, or immediately after surgery or after invasive procedures in adults or children. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We identified 65 completed trials (3874 participants) and four ongoing trials. Of the 65 completed trials, 39 focused on adult cardiac surgery, three on paediatric cardiac surgery, 12 on orthopaedic surgery, two on plastic surgery, and two on vascular surgery; seven studies were conducted in surgery for other conditions. These trials were conducted between 1986 and 2016, and 11 were funded by pharmaceutical companies or by a party with a commercial interest in the outcome of the trial. The GRADE quality of evidence was very low to moderate across all outcomes. No trial reported quality of life. DDAVP versus placebo or no treatment Trial results showed considerable heterogeneity between surgical settings for total volume of red cells transfused (low-quality evidence) and for total blood loss (very low-quality evidence) due to large differences in baseline blood loss. Consequently, these outcomes were not pooled and were reported in subgroups. Compared with placebo, DDAVP may slightly decrease the total volume of red cells transfused in adult cardiac surgery (mean difference (MD) -0.52 units, 95% confidence interval (CI) -0.96 to -0.08 units; 14 trials, 957 participants), but may lead to little or no difference in orthopaedic surgery (MD -0.02, 95% CI -0.67 to 0.64 units; 6 trials, 303 participants), vascular surgery (MD 0.06, 95% CI -0.60 to 0.73 units; 2 trials, 135 participants), or hepatic surgery (MD -0.47, 95% CI -1.27 to 0.33 units; 1 trial, 59 participants). DDAVP probably leads to little or no difference in the total number of participants transfused with blood (risk ratio (RR) 0.96, 95% CI 0.86 to 1.06; 25 trials; 1806 participants) (moderate-quality evidence). Whether DDAVP decreases total blood loss in adult cardiac surgery (MD -135.24 mL, 95% CI -210.80 mL to -59.68 mL; 22 trials, 1358 pa...

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Treatment with Procoagulants

Bolliger

Spanjersberg

2019

Patient Blood Management in Cardiac Surgery

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Desmopressin after cardiac surgery in bleeding patients. A multicenter randomized trial

Abstract: This multicenter randomized trial demonstrated that, in patients pre-treated with tranexamic acid, desmopressin should not be expected to improve treatment of patients who experience bleeding after cardiac surgery.

Cited by 18 publications

References 22 publications

Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta‐analysis of randomized controlled trials

Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta‐analysis of randomized controlled trials

Desmopressin use for minimising perioperative blood transfusion

Treatment with Procoagulants

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