Utilization and Effectiveness of Desmopressin Acetate After Cardiac Surgery Supplemented With Point-of-Care Hemostatic Testing: A Propensity-Score-Matched Analysis.
OBJECTIVE
To explore the utilization pattern and hemostatic effectiveness of desmopressin acetate (DDAVP) supplemented with point-of-care (POC) hemostatic testing in contemporary cardiac surgery.


METHODS
Retrospective, observational study.


METHODS
Single quaternary care university hospital.


METHODS
The study comprised 2,468 consecutive patients undergoing cardiac surgery-1,237 before and 1,231 after the introduction of POC testing.


METHODS
The incidence of DDAVP administration during the year before (2012) and after (2013) the initiation of POC-based viscoelastic (ROTEM; Tem International GmBH, Munich, Germany) and platelet function (Plateletworks; Helena Laboratories, Beaumont, TX) testing was determined. Propensity-score matching was used to examine the association between DDAVP administration and major bleeding during each time period.


RESULTS
DDAVP was administered more than twice as often after POC implementation (41% v 20%, p<0.001). Major bleeding was defined based on the universal definition of perioperative bleeding in adult cardiac surgery. Propensity matching identified 224 well-balanced pairs of DDAVP recipients and control patients before and 298 such pairs after the implementation of POC testing. After adjusting for matched data, DDAVP administration was associated with 1.70 (95% confidence interval 1.25-2.32, p<0.001) and 1.51 (95% confidence interval 1.15-1.98, p = 0.003) increases in the odds of major bleeding before and after the initiation of POC testing, respectively.


CONCLUSIONS
Clinicians should be cognizant of the potential for increased use of DDAVP despite limited evidence of benefit in contemporary cardiac anesthesia practice supplemented with POC-based hemostatic testing.
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada. Electronic address: david.orlov@uhn.ca.
David
D
Orlov
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
Stuart A
SA
McCluskey
Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Jeannie
J
Callum
Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
Vivek
V
Rao
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
Jacobo
J
Moreno
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
Keyvan
K
Karkouti
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D005260:Female; D006487:Hemostasis / Q000187:drug effects / Q000502:physiology; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D000067716:Point-of-Care Testing / Q000639:trends*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D057216:Propensity Score; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
D006490:Hemostatics; D003894:Deamino Arginine Vasopressin
blood coagulation; cardiac surgery; desmopressin acetate; extracorporeal circulation; hemorrhage; hemostasis; point of care testing