title: Patients with severe aortic valve stenosis and impaired platelet function benefit from preoperative desmopressin infusion.
abstract: BACKGROUND
  Patients with severe aortic valve stenosis have a markedly reduced platelet function as measured by a prolonged collagen adenosine diphosphate closure time (CADP-CT) determined by the platelet function analyzer PFA-100. We hypothesized that such patients may benefit from desmopressin when they present with prolonged CADP-CT due to the specific action of desmopressin on von Willebrand factor (VWF) and CADP-CT.
  
  
  METHODS
  In this double-blind, randomized placebo controlled trial, 43 patients undergoing aortic valve replacement (due to severe aortic valve stenosis with CADP-CT>170 seconds) were given desmopressin 0.3 μg/kg or saline intravenously after induction of anesthesia. Measurement of CADP-CT, factor VIII activity, von Willebrand factor antigen, GpIb binding activity, ristocetin cofactor activity, collagen-binding activity, and multimers were performed after induction of anesthesia, one hour after desmopressin infusion, and 24 hours postoperatively.
  
  
  RESULTS
  In the majority of patients, baseline values of von Willebrand factor related indices were normal, but increased one hour after infusion of desmopressin by 73% to 90% as compared with placebo. Selective loss of high molecular weight multimers was seen only in a minority of patients. The CADP-CT was greater than 170 seconds in 92% of screened patients, and desmopressin shortened CADP-CT by 48% versus baseline and reduced postoperative blood loss by 42% (p<0.001).
  
  
  CONCLUSIONS
  Prolonged CADP-CT indicates platelet dysfunction in severe aortic valve stenosis, and can guide the use of desmopressin as an effective prohemostatic agent in patients with severe aortic valve stenosis.
authors: Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors: Barbara
authors: B
authors: Steinlechner
authors: Petra
authors: P
authors: Zeidler
authors: Eva
authors: E
authors: Base
authors: Beatrice
authors: B
authors: Birkenberg
authors: Hendrik Jan
authors: HJ
authors: Ankersmit
authors: Michael
authors: M
authors: Spannagl
authors: Peter
authors: P
authors: Quehenberger
authors: Michael
authors: M
authors: Hiesmayr
authors: Bernd
authors: B
authors: Jilma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001791:Blood Platelet Disorders / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004311:Double-Blind Method; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006490:Hemostatics / Q000008:administration & dosage; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D003894:Deamino Arginine Vasopressin