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Treatment with desmopressin acetate in routine coronary artery bypass surgery to improve postoperative hemostasis
W D Lazenby1, I Russo, B J Zadeh
1Department of Cardiothoracic Surgery, New York Hospital-Cornell Medical Center, NY 10021.
Insights
Desmopressin acetate (DDAVP) did not reduce blood loss or transfusions in routine coronary artery bypass grafting. However, it improved platelet function in a subgroup with poor baseline aggregometry.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Hematology
Background:
- Desmopressin acetate (DDAVP) effectively reduces blood loss in complex cardiac surgeries.
- Its efficacy in routine coronary artery bypass grafting (CABG) remains undefined.
- Previous studies showed no benefit in routine valve operations.
Purpose of the Study:
- To evaluate the effect of DDAVP on blood loss and transfusion requirements in patients undergoing uncomplicated primary CABG.
- To assess DDAVP's impact on platelet function in this patient population.
Main Methods:
- Prospective study of 60 patients undergoing primary CABG.
- 30 patients received DDAVP (0.3 mcg/kg) post-cardiopulmonary bypass; 30 served as controls.
- Mediastinal blood loss, transfusion rates, and platelet aggregometry (ADP, collagen, ristocetin) were measured.
Main Results:
- No significant difference in 12-hour or 12-24-hour mediastinal blood loss between groups.
- Similar transfusion requirements for both DDAVP and control groups.
- DDAVP improved ristocetin-induced platelet aggregometry in patients with poor baseline function, but without a reduction in blood loss.
Conclusions:
- DDAVP does not appear to be beneficial in reducing blood loss or transfusion needs in routine, uncomplicated primary CABG.
- DDAVP may improve platelet function in specific patient subgroups, but this did not translate to clinical hemostatic benefits.
- Preoperative use of aspirin or NSAIDs negated any potential benefits of DDAVP.
Abstract:
Desmopressin acetate (DDAVP) has been shown to decrease blood loss and transfusions in complex cardiac operations with long extracorporeal times. Its use in routine cardiac valve operations has been shown not to be beneficial, but its role in routine coronary artery bypass grafting operations has not been defined. We examined the effect of DDAVP in a prospective study of 60 patients undergoing uncomplicated primary coronary artery bypass grafting operations. Thirty consecutive patients received DDAVP (0.3 micrograms/kg) after cardiopulmonary bypass and were compared with 30 consecutive patients who did not receive DDAVP. No significant differences were seen in 12-hour mediastinal blood loss (465 +/- 207 ml with DDAVP versus 511 +/- 221 ml without DDAVP) or 12-24-hour mediastinal blood loss (236 +/- 127 ml with DDAVP versus 260 +/- 112 ml without DDAVP). Transfusion of blood products were similar for both groups. Platelet aggregometry at intraoperative and postoperative time points using ADP, collagen, and ristocetin was not significantly different from baseline values in either group. In a subgroup of patients with poor initial ristocetin-induced platelet aggregometry, a significant increase (p less than 0.05) in ristocetin-induced platelet aggregometry was seen postoperatively only in those patients who had received DDAVP. A decrease in blood loss and transfusions, however, was not demonstrable. In those patients who had been on aspirin or nonsteroidal anti-inflammatory drugs preoperatively, DDAVP did not improve mediastinal blood loss or transfusion needs.(ABSTRACT TRUNCATED AT 250 WORDS)