Effect of Desmopressin on Platelet Aggregation and Blood Loss in Patients Undergoing Valvular Heart Surgery

Abstract

Background:Blood loss after cardiac surgery can be caused by impaired platelet (PLT) function after cardiopulmonary bypass. Desmopressin or 1-deamino-8-D-arginine vasopressin (DDAVP) is a synthetic analog of vasopressin. DDAVP can increase the level of von Willebrand factor and coagulation factor VIII, thus it may enhance PLT function and improve coagulation. In this study, we assessed the effects of DDAVP on PLT aggregation and blood loss in patients undergoing cardiac surgery.Methods:A total of 102 patients undergoing valvular heart surgery (from October 2010 to June 2011) were divided into DDAVP group (n = 52) and control group (n = 50). A dose of DDAVP (0.3 μg/kg) was administered to the patients intravenously when they were being re-warmed. At the same time, an equal volume of saline was given to the patients in the control group. PLT aggregation rate was measured with the AggRAM four-way PLT aggregation measurement instrument. The blood loss and transfusion, hemoglobin levels, PLT counts, and urine outputs at different time were recorded and compared.Results:The postoperative blood loss in the first 6 h was significantly reduced in DDAVP group (202 ± 119 ml vs. 258 ± 143 ml, P = 0.023). The incidence of fresh frozen plasma (FFP) transfusion was decreased postoperatively in DDAVP group (3.8% vs. 12%, P = 0.015). There was no significant difference in the PLT aggregation, urine volumes, red blood cell transfusions and blood loss after 24 h between two groups.Conclusions:A single dose of DDAVP can reduce the first 6 h blood loss and FFP transfusion postoperatively in patients undergoing valvular heart surgery, but has no effect on PLT aggregation.

Management of severe perioperative bleeding

“…A recent double-blind RCT (n ¼ 102) tested the effects of DDAVP on postoperative blood loss and platelet aggregation. 221 The intervention group was treated with 0.3 mg kg À1 during surgery and a control group received saline. The results showed a significant decrease in postoperative blood loss and FFP transfusions in the DDAVP group during the first 6 h post-surgery (the duration of drug activity).…”

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

“…It is the preferred treatment for VWD-related bleeding [125][126][127]. Clinical studies have shown that DDAVP improves postoperative platelet function and bleeding time in uremic patients [128], improves platelet aggregation in patients taking aspirin and/orclopidogrel [129][130][131], and reduces postoperative bleeding in cardiac patients taking aspirin [132,133], with very low incidences of cardiovascular and cerebral vascular thrombosis complications [134]. DDAVP (0.4 μ/kg iv over 30 min) may be given in cases of cerebral hemorrhage in patients receiving antiplatelet drugs or in cases of injury in VWD patients [135,136].…”

Effect of Desmopressin on the Amount of Bleeding and Transfusion Requirements in Patients Undergoing Heart Transplant Surgery

“…Results showed no significant difference between the two groups desmopressin and control. In addition, no significant difference was found between the two groups in terms of mechanical ventilation duration, cardiovascular side effects and ICU hospitalization .…”

“…Desmopressin shortens PTT and bleeding time (BT) although increased amounts of factor VIII and von Willebrand factor (vWF) are involved in the intrinsic pathway of coagulation and haemostasis . Desmopressin has no effect on the platelet number or aggregation; however, it strengthens the platelet adhesion to the vessel wall . Complications reported for desmopressin include mild facial flushing, headache, palpitations and hypotension .…”