Does tranexamic acid reduce desmopressin-induced hyperfibrinolysis?
OBJECTIVE
Desmopressin releases tissue-type plasminogen activator, which augments cardiopulmonary bypass--associated hyperfibrinolysis, causing excessive bleeding. Combined use of desmopressin with prior administration of the antifibrinolytic drug tranexamic acid may decrease fibrinolytic activity and might improve postoperative hemostasis.


METHODS
This prospective randomized study was carried out with 100 patients undergoing coronary artery bypass operations between April 1999 and November 2000 in Gülhane Military Medical Academy. Patients were divided into 2 groups. Desmopressin (0.3 microg/kg) was administrated just after cardiopulmonary bypass and after protamine infusion in group 1 (n = 50). Both desmopressin and tranexamic acid (before the skin incision at a loading dose of 10 mg/kg over 30 minutes and followed by 12 hours of 1 mg.kg(-1).h(-1)) were administrated in group 2 (n = 50).


RESULTS
Significantly less drainage was noted in group 2 (1010 +/- 49.9 mL vs 623 +/- 41.3 mL, P =.0001). Packed red blood cells were transfused at 2.1 +/- 0.5 units per patient in group 1 versus 0.9 +/- 0.3 units in group 2 (P =.0001). Fresh frozen plasma was transfused at 1.84 +/- 0.17 units per patient in group 1 versus 0.76 +/- 0.14 units in group 2 (P =.0001). Only 24% of patients in group 2 required donor blood or blood products compared with 74% of those in the isolated desmopressin group (group 1, P =.00001). Group 1 and group 2 findings were as follows: postoperative fibrinogen, 113 +/- 56.3 mg/dL versus 167 +/- 45.8 mg/dL (P =.0001); fibrin split product, 21.2 +/- 2.3 ng/mL versus 13.5 +/- 3.4 ng/mL (P =.0001); and postoperative hemoglobin level, 7.6 plus minus 1.2 g/dL versus 9.1 plus minus 1.2 g/dL (P =.0001).


CONCLUSIONS
Tranexamic acid administration significantly reduces desmopressin and bypass-induced hyperfibrinolysis. Combined use of tranexamic acid and desmopressin decreases both postoperative blood loss and transfusion requirement.
Ozal
Ertuğrul
E
Cardiovascular Surgery Department, Gülhane Military Medical Academy, Etlik, Ankara, Turkey 06010. ozal@tr.net
Kuralay
Erkan
E
Bingöl
Hakan
H
Cingöz
Faruk
F
Ceylan
Süleyman
S
Tatar
Harun
H
D000368:Aged; D000933:Antifibrinolytic Agents / Q000494:pharmacology*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003894:Deamino Arginine Vasopressin / Q000494:pharmacology*; D004347:Drug Interactions; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006488:Hemostasis, Surgical; D006490:Hemostatics / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000494:pharmacology*
D000933:Antifibrinolytic Agents; D006490:Hemostatics; D014148:Tranexamic Acid; D003894:Deamino Arginine Vasopressin