Desmopressin usage in elective cardiac surgery.
BACKGROUND
Desmopressin acetate (DDAVP) has been implicated as a promising agent to reduce blood loss in patients undergoing cardiopulmonary bypass.


METHODS
The effects of intraoperative desmopressin were studied in 66 patients undergoing coronary artery bypass grafting, randomized equally into desmopressin and control groups. The desmopressin group received 0.3 microg/kg desmopressin at the end of cardiopulmonary bypass.


RESULTS
Fibrinogen level of both groups significantly reduced at postoperative 2nd hr, whereas a significant rise was observed at postoperative 24th hr with an intergroup difference favoring the control group (p=0.0307). In the desmopressin group, the activation time of factor VIII shortened during the whole postoperative period being significant (p=0.0127) at postoperative 24th hr. Postoperative von Willebrand factor (vWF) levels of the desmopressin group were significantly higher than the preoperative ones. The control group did not show such important changes in factor VIII and vWF measurements. Platelet aggregation times of both groups prolonged at postoperative 2nd hr. The control group showed significant elevation in ADP induced aggregation time at 2nd hr and significant reductions of platelet activation percentage in response to ADP, epinephrine, collagen and ristocetin at 2nd hr. Postoperative blood loss as well as blood transfusion need did not differ between the two groups.


CONCLUSIONS
Despite the improved platelet functions, desmopressin does not seem to have obvious beneficial effects on postoperative hemostasis in patients without any bleeding disorder and undergoing elective cardiac surgery.
Ozkisacik
E
E
Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
Islamoğlu
F
F
Posacioğlu
H
H
Yağdi
T
T
Başarir
S
S
Omay
S B
SB
Ozbaran
M
M
Büket
S
S
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001026:Coronary Artery Bypass; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005169:Factor VIII / Q000187:drug effects / Q000378:metabolism; D005260:Female; D005340:Fibrinogen / Q000187:drug effects / Q000378:metabolism; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011517:Prothrombin Time; D016896:Treatment Outcome; D014841:von Willebrand Factor / Q000187:drug effects / Q000378:metabolism
D006490:Hemostatics; D014841:von Willebrand Factor; D005169:Factor VIII; D005340:Fibrinogen; D003894:Deamino Arginine Vasopressin