Desmopressin Has No Beneficial Effect on Excessive Postoperative Bleeding or Blood Product Requirements Associated with Cardiopulmonary Bypass

Abstract

SummaryCardiopulmonary bypass during open-heart surgery is sometimes associated with excessive perioperative bleeding. Following a non-randomized study suggesting that desmopressin acetate (desmopressin) reduced blood product requirements in these patients, we conducted a double-blind, placebo-controlled randomized trial of desmopressin (0.3 µg/kg, i. v.) in 92 patients with overt bleeding and a prolonged bleeding time.Mean blood loss during the first 24 h post-treatment was similar in the desmopressin and placebo groups (582 vs 465 ml, respectively; p = 0.15). Red-cell (p = 0.76), fresh frozen plasma (r = 0.66) and platelet unit (p = 0.74) requirements were also similar.The haemostatic effect of desmopressin has been attributed to the release of von Willebrand factor (vWF) and a reduced bleeding time. In our study, vWF and factor VIII :C levels increased while the bleeding time decreased significantly at 90 min and 24 h in both groups and, although vWF and factor VIII: C levels were slightly higher in desmopressin-treated patients at 90 min, the difference was not significant. Thrombin-antithrombin III complex, fibrinogen degradation product and tissue plasminogen activator levels, reflecting activation of the coagulation and fibrinolytic systems, respectively, decreased uniformely in both groups.We conclude that desmopressin is not useful in reducing blood loss or blood product requirements in patients with excessive immediate postoperative bleeding.

Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta‐analysis of randomized controlled trials

“…This outcome was reported in six trials . The risk of re‐operation because of bleeding was lower for participants treated with desmopressin compared with participants treated with placebo (pOR, 0.39; 95% CI, 0.18–0.84; I 2 = 0%; 413 participants; six trials; Fig.…”

“…Although all surgical procedures regardless of specialty were potentially eligible, all 10 relevant trials were in the setting of cardiac surgery. Six trials included participants undergoing coronary artery bypass grafting (CABG) [25][26][27][28][29][30], one trial included aortic valve replacements [31] and three trials included a combination of CABG and valve replacements [24,32,33]. Nine trials included only elective surgery [24][25][26][28][29][30][31][32][33] and one trial included only emergency cases [27].…”

“…Six trials included participants undergoing coronary artery bypass grafting (CABG) [25][26][27][28][29][30], one trial included aortic valve replacements [31] and three trials included a combination of CABG and valve replacements [24,32,33]. Nine trials included only elective surgery [24][25][26][28][29][30][31][32][33] and one trial included only emergency cases [27]. Platelet dysfunction was a result of antiplatelet agents in six trials: single-agent aspirin in four trials [25,26,29,30], dual antiplatelet therapy in one trial [27] and a combination of single-agent aspirin and dual antiplatelet therapy in one trial [24].…”

Efficacy of FK633, an ultra-short acting glycoprotein IIb/IIIa antagonist on platelet preservation during and after cardiopulmonary bypass

“…Prostanoids, particularly the prostacyclin analog "iloprost", incompletely inhibit platelet membrane receptors and are reversible, but cause profound and unacceptable hypotension [6]. Desmopressin [7] prevents platelet consumption in vitro but fails to preserve platelets in vivo.…”

Transfusion Medicine

“…[104] Desmopressin was shown initially to be effective in reducing perioperative blood loss and transfusion requirements in patients who undergo complex cardiac surgical procedures with prolonged extracorporeal circulation. [106][107][108][109][110][111] Individual patients who may derive benefit with desmopressin can be identified using point-of-care tests that measure platelet function. [106][107][108][109][110][111] Individual patients who may derive benefit with desmopressin can be identified using point-of-care tests that measure platelet function.…”