Treatment with Desmopressin Acetate to Reduce Blood Loss after Cardiac Surgery

Abstract

Bleeding after cardiopulmonary bypass remains a cause for concern, requiring reexploration of the chest in approximately 3 percent of patients who have had operations on the heart. We examined the possibility that this problem might be alleviated by desmopressin acetate (DDAVP), which increases the plasma level of von Willebrand factor and improves hemostasis in mild hemophilia and other conditions associated with defective platelet function. In a double-blind, prospective, randomized trial, we studied the effect of intraoperative desmopressin acetate in 70 patients undergoing various cardiac operations requiring cardiopulmonary bypass. Patients undergoing uncomplicated primary coronary-artery bypass grafting were not included. The drug significantly reduced mean operative and early postoperative blood loss (1317 +/- 486 ml in the treated group vs. 2210 +/- 1415 ml in the placebo group); of the 14 patients whose 24-hour blood loss exceeded 2000 ml, 11 had received the placebo. Plasma levels of von Willebrand factor were higher after desmopressin acetate than after placebo. Patients with the most bleeding had relatively low levels of von Willebrand factor before operation, suggesting a role for this factor in the hemorrhagic tendency induced by extracorporeal circulation. There were no untoward side effects of desmopressin acetate. We conclude that the administration of desmopressin acetate can be recommended to reduce blood loss in patients undergoing complex cardiac operations. The beneficial effect of the drug on hemostasis after cardiopulmonary bypass may be related to its effect on von Willebrand factor.

The use of desmopressin as a hemostatic agent: A concise review

“…In a study of 70 patients undergoing cardiac surgery, desmopressin was able to reduce blood loss and transfusion requirements by about 30% [51]. However, subsequent studies did not confirm these preliminary results.…”

Tranexamic acid reduces blood loss and transfusion in reoperative cardiac surgery

“…[19][20][21][22] Aprotinin is a serine protease inhibitor that has been the most thoroughly investigated for its effect on blood loss during cardiac surgery reviews, s,16,zs,24 For many years, cardiopulmonary bypass surgery has been thought to be associated with increased fibrinolysis 2s-27 that is a major contributor to bleeding. 2s The cause of increased bleeding after ECC has not been elucidated but it is thought to be due to platelet dysfunction as well as to activation of the coagulation cascade leading to excessive fibrinolysis.…”

Haemostatic management of cardiac surgical haemorrhage

“…The evidence for the use of DDAVP in cardiac surgery comes from two trials which showed that, in small cohorts of patients undergoing complex cardiac surgery, DDAVP administration led to a reduction in mean 24-h blood loss compared with placebo, and those patients with the lowest vWF levels benefitted the most [61,62]. Subsequent trials have failed to show a reduction in blood loss following DDAVP administration.…”