title: Effect of desmopressin acetate on hemorrhage without identifiable cause in coronary bypass patients.
abstract: After early hopeful reports, the ability of desmopressin acetate (DDAVP) to substantially reduce post surgical hemorrhage has been questioned. A total of 74 elective coronary bypass patients (Group A) receiving DDAVP (0.3 micrograms/kg) who, in the opinion of the operating surgeon, did not achieve adequate hemostasis after protamine neutralization of heparin were studied. They were compared with 91 age- and sex-matched controls (Group B). Before surgery there was no difference in hematocrit (40.8% vs. 40.3%); bleeding time (5.3 vs. 4.9 sec); platelet count (267 +/- 8 vs. 309 +/- 13 X 10(3)/mm3); fibrinogen (363 vs. 361 mg/dl); or activated clotting time (ACT) (168 +/- 4 vs. 163 +/- 3 sec). Both groups had the same number of grafts (3.3/pt), use of the mammary artery (72%), and average bypass time (124 min). There were also no differences in postbypass ACT (142 +/- 3 vs. 135 +/- 2 sec); platelet count (97 +/- 10 vs. 120 +/- 24 X 10(3)/mm3); and fibrinogen (157 +/- 35 vs. 207 +/- 40 mg/dl). However, postoperative hemorrhage was strikingly different: 1306 +/- 89 vs. 896 +/- 33 ml (P less than .0001). Fifteen patients in Group A bled more than 1.5 liters compared with 4 in Group B. Red cell transfusion rates were 1.23 +/- 0.26 for Group A and 0.35 +/- 0.8 for Group B (P less than 0.005). Sixteen Group A patients received additional blood products (plasma and platelets). The hemorrhage difference remained significant even when these patients were excluded (1098 +/- 57 vs. 896 +/- 34, P less than 0.003). Three Group A patients were re-explored without a bleeding source located.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery, Northwestern University Medical School, Chicago, Illinois 60611-308.
authors.forename: J L
authors.initials: JL
authors.lastname: Cicero
authors.forename: M
authors.initials: M
authors.lastname: Massad
authors.forename: J
authors.initials: J
authors.lastname: Matano
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D012501:Saphenous Vein / Q000637:transplantation; D012737:Sex Factors
chemical_list: D003894:Deamino Arginine Vasopressin