Repeated dose administration of desmopressin acetate in uncomplicated cardiac surgery: A prospective, blinded, randomized study

Marquez, José; Koehler, Swaroop; Strelec, Stephen R.; Benckart, Daniel H.; Spero, Joel A.; Cottington, Eric; Torpey, David J.

doi:10.1016/1053-0770(92)90049-d

Cited by 33 publications

(35 citation statements)

References 7 publications

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“…Nine studies were excluded because no clinical outcome other than blood loss was available, [7][8][9][10][11][12][13][14][15] eight studies were found not to be randomized after more thorough analysis, [16][17][18][19][20][21][22][23] five studies concerned cardiac surgery in child- ren, [24][25][26][27][28] and there was one double report. 29,36 66,75,[86][87][88][89][90][91][92][93][94][95][96][97][98][99] In addition, 12 studies compared treatment with the conventional dose of aprotinin with lower doses of aprotinin. 30,38,40,41,44,46,48,50,56,…”

Section: Literature Search and Methodological Gradingmentioning

confidence: 99%

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

Levi¹,

Cromheecke²,

Jonge³

et al. 2001

Transfus Alt Transfus Med

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SUMMARY Background: Excessive bleeding may complicate cardiac surgery, and is associated with increased morbidity and mortality. Pharmacological strategies to decrease perioperative bleeding have been investigated in a large number of controlled trials, most of which have shown a decrease in blood loss. However, most studies lacked sufficient power to detect a beneficial effect on clinically more relevant outcomes. We did a meta‐analysis of all randomized, controlled trials of the three most frequently used pharmacological strategies to decrease perioperative blood loss (aprotinin, lysine analogues [aminocaproic acid and tranexamic acid], and desmopressin). Methods: Studies were included if they reported at least one clinically relevant outcome (mortality, rethoracotomy, proportion of patients receiving a transfusion, or perioperative myocardial infarction) in addition to perioperative blood loss. In addition, a separate meta‐analysis was done for studies concerning complicated cardiac surgery. Findings: We identified 72 trials (8409 patients) that met the inclusion criteria. Treatment with aprotinin decreased mortality almost two‐fold (odds ratio 0.55 [95% CI 0.34‐0.90]) compared with placebo. Treatment with aprotinin and with lysine analogues decreased the frequency of surgical re‐exploration (0.37 [0.25‐0.55], and 0.44 [0.22‐0.90], respectively). These two treatments also significantly decreased the proportion of patients receiving any allogeneic blood transfusion. By contrast, the use of desmopressin resulted in a small decrease in perioperative blood loss, but was not associated with a beneficial effect on other clinical outcomes. Aprotinin and lysine analogues did not increase the risk of perioperative myocardial infarction; however, desmopressin was associated with a 2.4‐fold increase in the risk of this complication. Studies in patients undergoing complicated cardiac surgery showed similar results. Interpretation: Pharmacological strategies that decrease perioperative blood loss in cardiac surgery, in particular aprotinin and lysine analogues, also decrease mortality, the need for rethoracotomy, and the proportion of patients receiving a blood transfusion.

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Section: Literature Search and Methodological Gradingmentioning

confidence: 99%

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

Levi¹,

Cromheecke²,

Jonge³

et al. 2001

Transfus Alt Transfus Med

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“…On the other hand, in two subsequent large studies of patients undergoing less complex operations with lesser blood loss, there were no significant differences between desmopressin-and placebo-treated patients in terms of total blood loss or transfusion requirements [27,28]. Other studies, mainly in patients undergoing coronary artery bypass grafting and uncomplicated valve replacement, gave conflicting results [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47].…”

Section: Clinical Trials Of Desmopressin In Open-heart Surgerymentioning

confidence: 99%

The use of desmopressin in open‐heart surgery

Cattaneo

2007

Haemophilia

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Desmopressin (l-deamino-8-D-arginine vasopressin, DDAVP) is a synthetic analogue of the antidiuretic hormone vasopressin. Like the natural antidiuretic hormone, desmopressin increases the plasma levels of factor VIII and von Willebrand factor (vWF), with the advantage, compared to vasopressin, that it produces little or no vasoconstriction, no increase in blood pressure, and no contraction of the uterus or gastrointestinal tract, so that it is well tolerated when administered to humans. In 1977, desmopressin was used for the first time in patients with mild hemophilia A and von Willebrand disease (vWD) for the prevention and treatment of bleeding, first during dental extractions and then during major surgical procedures. The clinical indications for desmopressin rapidly expanded beyond hemophilia and vWD. The compound was shown to be efficacious even in bleeding disorders not involving a deficiency or dysfunction of factor VIII or vWF, including congenital and acquired defects of platelet function and such frequent abnormalities of hemostasis as those associated with chronic kidney and liver diseases. Desmopressin has also been used prophylactically in patients undergoing surgical operations characterized by large blood loss and transfusion requirements.

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“…One possible explanation of why desmopressin has had little effect may be that in most studies it has been given as one single dose. The half life of the effects on factor VIII and von Willebrand factor is only six to eight hours and there are indications that it is helpful to give a second dose (68).…”

Section: Other Types Of Operationmentioning

confidence: 99%

“…In patients with platelet dysfunction (prolonged bleeding time), being given various combinations of the drugs shown in Table III, desmopressin is effective in reducing bleeding (19,25,30,68,79).…”

Section: Desmopressin and Perioperative Platelet Dysfunctionmentioning

confidence: 99%

Use of desmopressin to prevent bleeding in surgery

Flordal

2003

Eur J Surg

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Repeated dose administration of desmopressin acetate in uncomplicated cardiac surgery: A prospective, blinded, randomized study

Cited by 33 publications

References 7 publications

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

The use of desmopressin in open‐heart surgery

Use of desmopressin to prevent bleeding in surgery

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