Thromb Haemost 1992; 68(02): 106-110
DOI: 10.1055/s-0038-1656332
Original Article
Schattauer GmbH Stuttgart

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

D de Prost
1   Service d'immunologie et d'hématologie and INSERM U 294, Paris, France
,
G Barbier-Boehm
2   Département d'anesthésie, Paris, France
,
J Hazebroucq
2   Département d'anesthésie, Paris, France
,
H Ibrahim
2   Département d'anesthésie, Paris, France
,
M C Bielsky
3   ETEST, Paris, France
,
U Hvass
4   Service de chirurgie cardiovasculaire, CHU Xavier Bichat, Paris, France
,
C Lacombe
1   Service d'immunologie et d'hématologie and INSERM U 294, Paris, France
,
J L Français
1   Service d'immunologie et d'hématologie and INSERM U 294, Paris, France
,
J M Desmonts
2   Département d'anesthésie, Paris, France
› Author Affiliations
Further Information

Publication History

Received 08 January 1992

Accepted after revision 19 March 1992

Publication Date:
03 July 2018 (online)

Summary

Cardiopulmonary 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.

 
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