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Desmopressin acetate following cardiopulmonary bypass: evaluation of coagulation parameters
M R Brown1, T H Swygert, C W Whitten
1Department of Anesthesiology, Baylor University Medical Center, Dallas, TX 75246.
Insights
Desmopressin acetate (DDAVP) did not significantly reduce bleeding or improve coagulation during coronary artery bypass grafting (CABG). The study found no benefits to justify its routine use in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Desmopressin acetate (DDAVP) is suggested to reduce mediastinal bleeding after cardiopulmonary bypass (CPB).
- Its efficacy in routine coronary artery bypass grafting (CABG) remains unevaluated.
- Platelet dysfunction is a concern in CABG patients.
Purpose of the Study:
- To evaluate the efficacy of DDAVP in reducing bleeding and improving hemostasis during elective CABG.
- To assess DDAVP's impact on platelet function and coagulation parameters using thromboelastography (TEG).
Main Methods:
- A randomized, double-blind, placebo-controlled study involving 20 patients undergoing elective CABG.
- Patients received either DDAVP (0.3 microgram/kg IV) or placebo after heparin reversal post-CPB.
- Hemostasis was monitored using TEG and conventional coagulation tests.
Main Results:
- No significant differences in hemostasis or blood product transfusion were observed between DDAVP and placebo groups.
- A minor difference in postoperative PTT was noted (P=0.03), but without clinical significance.
- Hypotension occurred in four patients receiving DDAVP, with no such events in the placebo group.
Conclusions:
- DDAVP therapy does not offer significant benefits for routine use in CABG.
- The cost and potential complications of DDAVP outweigh its unproven advantages in this setting.
Abstract:
Desmopressin acetate (DDAVP) has been advocated as efficacious in reducing mediastinal bleeding following cardiopulmonary bypass (CPB), and has been shown to ameliorate platelet dysfunction; however, this has not been evaluated during routine coronary artery bypass grafting (CABG). In the present study, this therapy was evaluated utilizing the thromboelastograph (TEG), a rapid, on-line means of diagnosing a coagulopathy. During elective CABG, 20 patients received either DDAVP, 0.3 microgram/kg, intravenously, following heparin reversal after CPB, or a placebo infusion, in a randomized, double-blind fashion. Hemostasis was monitored with both the TEG and conventional coagulation tests. No significant differences between the two groups were found at induction, postprotamine, post-"study infusion," or 2 hours postoperatively, with the exception of the postoperative PTT (31.1 +/- 3.2 v 36.5 +/- 5.9 seconds for DDAVP v placebo, P = 0.03). Total blood products transfused intraoperatively, and in the first 8, 16, 24, or 48 postoperative hours, were also similar between the groups. No manifestations of hypercoagulability were seen, but hypotension during the infusion was noted in four patients receiving DDAVP, and in none of the controls. It is concluded that the expense and potential complications of DDAVP therapy do not justify its routine use in CABG.