Effects of desmopressin acetate on platelet aggregation, von Willebrand factor, and blood loss after cardiac surgery with extracorporeal circulation.

Abstract

The effects of desmopressin acetate (DDAVP) on platelet aggregation and the von Willebrand factor antigen (vWF: Ag) were studied in 19 patients undergoing cardiac surgery with extracorporeal circulation. The patients represented one of five blocks in a randomized double-blind placebo-controlled parallel group trial on the effects of DDAVP on postoperative bleeding after uncomplicated coronary artery bypass operations. After termination of extracorporeal circulation, DDAVP (0.3 jig/kg body wt) or its vehicle was infused into a peripheral vein throughout 15 minutes. The increase in factor VIII coagulant activity after infusion did not differ between the groups but there was a significantly larger increase in vWF: Ag levels in DDAVP-treated patients. The aggregatory response to adenosine-diphosphate (ADP) and ristocetin showed a normal pattern and was not significantly different between the two groups. As compared with placebo, DDAVP did not decrease the bleeding time or the postoperative blood loss. We conclude that DDAVP causes an increase in vWFF:Ag levels but does not alter platelet aggregation, bleeding time, or blood loss in uncomplicated coronary artery bypass patients. (Circulation 1990;81:872-878) Acommon problem in cardiac surgery is increased bleeding tendency after cardiopulmonary bypass. The hemostatic defect can be caused by several factors such as a decrease in plasma coagulation factors, increased fibrinolytic activity, inadequate reversal of heparinization, or reduced platelet count as well as defects in platelet function.1,2Desmopressin acetate (DDAVP) can reduce bleeding in patients with mild hemophilia A and most types of von Willebrand's disease. It also seems to be effective in some patients with congenital or acquired platelet function defects,34 including abnormalities associated with uremia5 and intake of aspirin.6 Infusion of DDAVP is known to increase From the

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

“…Of these 142 trials, 95 were apparently randomized, controlled studies. Nine studies were excluded because no clinical outcome other than blood loss was available, [7][8][9][10][11][12][13][14][15] eight studies were found not to be randomized after more thorough analysis, [16][17][18][19][20][21][22][23] five studies concerned cardiac surgery in child- ren, [24][25][26][27][28] and there was one double report. 29,36 66,75,[86][87][88][89][90][91][92][93][94][95][96][97][98][99] In addition, 12 studies compared treatment with the conventional dose of aprotinin with lower doses of aprotinin.…”

Pharmacotherapeutic Management of Gastrointestinal Bleeding in Patients with Continuous‐Flow Left Ventricular Assist Devices

“…Currently, to our knowledge, there are no agents directed at improving functionality of platelets with respect to induced platelet aggregation. Although DDAVP has been shown to be effective in patients with acquired platelet function defects, results suggest that it can increase vWF:Ag levels but does not alter platelet aggregation . An area of potential research could include development of agents directed toward inducing platelet aggregation.…”

“…Although DDAVP has been shown to be effective in patients with acquired platelet function defects, results suggest that it can increase vWF:Ag levels but does not alter platelet aggregation. 80 An area of potential research could include development of agents directed toward inducing platelet aggregation. Although other mechanisms of GIB have been focused on to greater extent, this represents a potential area of research.…”

The use of desmopressin in open‐heart surgery

“…On the other hand, in two subsequent large studies of patients undergoing less complex operations with lesser blood loss, there were no significant differences between desmopressin-and placebo-treated patients in terms of total blood loss or transfusion requirements [27,28]. Other studies, mainly in patients undergoing coronary artery bypass grafting and uncomplicated valve replacement, gave conflicting results [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47].…”