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Desmopressin does not decrease bleeding after cardiac operation in young children
L M Reynolds1, S C Nicolson, D R Jobes
1Department of Anesthesiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.
Insights
Desmopressin did not reduce blood loss in young children after complex cardiac surgery. This study found no significant difference in blood loss or replacement between desmopressin and placebo groups.
Area of Science:
- Pediatric Cardiac Surgery
- Hemostasis and Thrombosis
- Pharmacology
Background:
- Young children undergoing complex cardiac operations experience significant blood loss post-cardiopulmonary bypass.
- Effective strategies to minimize perioperative blood loss in pediatric cardiac surgery are crucial.
Purpose of the Study:
- To investigate the efficacy of desmopressin in reducing blood loss within 24 hours after cardiopulmonary bypass in pediatric patients undergoing complex cardiac procedures.
Main Methods:
- A randomized, blinded trial comparing desmopressin (0.3 microgram/kg) versus placebo in 112 pediatric patients.
- Coagulation profiles were assessed pre- and post-operatively.
- Blood loss and replacement were meticulously recorded for 24 hours post-operation.
Main Results:
- No statistically significant difference in 24-hour blood loss (desmopressin 30 ± 33 ml/kg vs. placebo 35 ± 36 ml/kg) or blood replacement was observed.
- Coagulation profiles remained similar between the desmopressin and placebo groups at all measured time points.
- Patient demographics, including age, weight, and surgical complexity, were comparable between groups.
Conclusions:
- Desmopressin administration does not effectively reduce blood loss or the need for blood replacement in young children following cardiopulmonary bypass for cardiac surgery.
- The findings suggest desmopressin is not beneficial for managing perioperative bleeding in this pediatric population.
Abstract:
Young children undergoing complex cardiac operation lose more blood after cardiopulmonary bypass than do older patients. This study was designed to investigate the effect of desmopressin on blood loss during the first 24 hours after cardiac operation in children undergoing principally complex surgical procedures. The study consisted of a randomized, blinded comparison of 112 pediatric patients who received either desmopressin 0.3 microgram/kg or saline solution placebo after cardiopulmonary bypass. A coagulation profile including bleeding time, quantitation of von Willebrand factor, and qualitative analysis of the factor VII:von Willebrand factor complex was performed before, 30 minutes after, and 3 hours after the operation. Blood loss and blood replacement were recorded for the first 24 hours after the operation. The surgeon classified the technical difficulty of each procedure as simple or complex. Statistical analysis was performed with Student's unpaired t test and chi 2 analysis. Significance was defined as p < 0.05. Results are listed as mean +/- standard deviation. Data collection was completed for 95 patients. The mean age of all patients was 26 +/- 40 months, and the mean weight was 10 +/- 11 kg, with 84% undergoing complex procedures. There were no differences between the desmopressin and placebo groups with respect to age, weight, or surgical complexity. Twenty-four-hour blood loss and replacement between the desmopressin and placebo groups were not different (blood loss: desmopressin 30 +/- 33 ml/kg, placebo 35 +/- 36; blood replacement: desmopressin 65 +/- 43 ml/kg, placebo 64 +/- 46 ml/kg). Coagulation profiles between the desmopressin and placebo groups were not different at any time. We conclude that desmopressin does not reduce blood loss or blood replacement in young children after cardiopulmonary bypass for either simple or complex cardiac surgical procedures.