The effect of desmopressin acetate on postoperative hemorrhage in patients receiving aspirin therapy before coronary artery bypass operations

Gratz, Irwin; Koehler, Joseph; Olsen, D. J.; Afshar, Mary; deCastro, N G; Spagna, Paschal M.; Ablaza, Sariel G.G.; Larijani, Ghassem E.

doi:10.1016/s0022-5223(19)34638-0

Cited by 85 publications

(66 citation statements)

References 25 publications

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“…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%

“…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]. Platelet dysfunction was a result of CPB in four trials [28,[31][32][33].…”

Section: Trial Characteristicsmentioning

confidence: 99%

“…Desmopressin was administered as a single intravenous dose of 0.3 lg kg À1 in eight trials [24][25][26][27][28][29]31,32], 0.4 lg kg À1 in one trial [33] and 10 lg m À2 body surface area in one trial [30]. One trial was a four-arm trial comparing desmopressin 0.3 lg kg À1 , standard care, a combination of desmopressin 0.3 lg kg À1 with tranexamic acid, and tranexamic acid as a single agent [27].…”

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

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: Trial Characteristicsmentioning

confidence: 99%

Section: Trial Characteristicsmentioning

confidence: 99%

Section: Trial Characteristicsmentioning

confidence: 99%

Section: Trial Characteristicsmentioning

confidence: 99%

See 2 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

104

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“…after injection of desmopressin. Dilthey et al did not find significant difference in the volume of bleeding, but they found a significant reduction in the transfusion requirements and a significant increase in vWF 4 hr after desmopressin infusion [37]. In another study by Reynolds et al [38] in 95 children who underwent simple and complex cardiac surgery, there was no difference between the desmopressin and placebo groups in terms of reducing bleeding 24 hr after surgery, transfusion requirements and coagulation factors.…”

Section: Discussionmentioning

confidence: 94%

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

Jahangirifard

Razavi

Ahmadi

et al. 2017

Basic Clin Pharma Tox

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One of the most common risks after a heart transplant is bleeding. In this study, the effect of desmopressin administration on the amount of bleeding and transfusion requirements after heart transplant surgery was investigated. In a double-blind clinical trial, 48 patients who were candidates for heart transplant surgery were randomly assigned to two groups. In the intervention group, patients received desmopressin of 0.3 μg/kg, 30 min. before surgery. Patients in the control group received normal saline at the same amount and time. Homeostasis was evaluated using activated clotting time (ACT), PT, PTT and PLT before, 12 and 24 hr after surgery, and also, chest tube drainage, blood products transfusion requirements during the first day in both groups. No significant differences were found between the groups in terms of ACT, PT, PTT and PLT at all times. Transfusion of packed red blood cells and the mean drainages of chest tube during the first 24 hr after surgery were significantly lower in the desmopressin group compared to the saline group. Desmopressin may reduce post-operative bleeding in patients undergoing heart transplant surgery. Further studies are required to confirm the potential effect of desmopressin on establishing haemostasis after heart transplantation.

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Desmopressin for minimising perioperative allogeneic blood transfusion

Henry¹,

Moxey²,

Carless³

et al. 1998

Cochrane Database of Systematic Reviews

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Analysis 2.3. Comparison 2 Adverse events and other outcomes, Outcome 3 Myocardial infarction. . . . . . . Analysis 2.4. Comparison 2 Adverse events and other outcomes, Outcome 4 Stroke (CVA). . . . . . . . . . Analysis 2.5. Comparison 2 Adverse events and other outcomes, Outcome 5 Any thrombosis. . . . . . . . . Analysis 2.6. Comparison 2 Adverse events and other outcomes, Outcome 6 Hypotension -during DDAVP/Placebo infusion requiring treatment (fluids and/or vasoactive drugs).

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The effect of desmopressin acetate on postoperative hemorrhage in patients receiving aspirin therapy before coronary artery bypass operations

Cited by 85 publications

References 25 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

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

Desmopressin for minimising perioperative allogeneic blood transfusion

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