Desmopressin for haemostasis in cardiac surgery: when to use?

Bleeding after cardiac surgery increases morbidity and exposes patients to the risks associated with blood transfusion. Desmopressin acetate, a synthetic vasopressin analogue, has been used in patients undergoing cardiac operations to reduce postoperative blood loss and transfusion requirements, although a benefit has not been demonstrated in large randomized controlled trials. Therefore, the routine use of desmopressin in uncomplicated cardiac operations is not recommended. This review article discusses the pharmacology of desmopressin as a haemostatic agent and evaluates available clinical evidence to determine current indications for desmopressin as a haemostatic agent in cardiac surgery.