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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2001 December;42(6):741-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Desmopressin usage in elective cardiac surgery

Özkisacik E., Islamoglu F., Posacioglu H., Yagdi T., Basarir S., Omay S. B. *, Özbaran M., Büket S.

From the Department of Cardiovascular Surgery
*Department of Haemotology Ege University Medical Faculty, Izmir, Turkey


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Background. Desmopressin ace­tate (­DDAVP) has ­been impli­cat­ed as a prom­is­ing ­agent to ­reduce ­blood ­loss in ­patients under­go­ing car­di­o­pul­mo­nary ­bypass.
Methods. The ­effects of intra­op­er­a­tive desmo­pres­sin ­were stud­ied in 66 ­patients under­go­ing cor­o­nary ­artery ­bypass graft­ing, ran­dom­ized equal­ly ­into desmo­pres­sin and con­trol ­groups. The desmo­pres­sin ­group ­received 0.3 µg/kg desmo­pres­sin at the end of car­di­o­pul­mo­nary ­bypass.
Results. Fibrinogen lev­el of ­both ­groups sig­nif­i­cant­ly ­reduced at post­op­er­a­tive 2nd hr, where­as a sig­nif­i­cant ­rise was ­observed at post­op­er­a­tive 24th hr ­with an inter­group dif­fer­ence favor­ing the con­trol ­group (p=0.0307). In the desmo­pres­sin ­group, the acti­va­tion ­time of fac­tor ­VIII short­ened dur­ing the ­whole post­op­er­a­tive peri­od ­being sig­nif­i­cant (p=0.0127) at post­op­er­a­tive 24th hr. Postoperative von Willebrand fac­tor (vWF) lev­els of the desmo­pres­sin ­group ­were sig­nif­i­cant­ly high­er ­than the pre­op­er­a­tive ­ones. The con­trol ­group did not ­show ­such impor­tant chang­es in fac­tor ­VIII and vWF meas­ure­ments. Platelet aggre­ga­tion ­times of ­both ­groups pro­longed at post­op­er­a­tive 2nd hr. The con­trol ­group ­showed sig­nif­i­cant ele­va­tion in ADP ­induced aggre­ga­tion ­time at 2nd hr and sig­nif­i­cant reduc­tions of plate­let acti­va­tion per­cents in ­response to ADP, epi­neph­rine, col­la­gen and ris­toc­e­tin at 2nd hr. Postoperative ­blood ­loss as ­well as ­blood trans­fu­sion ­need did not dif­fer ­between the two ­groups.
Conclusions. Despite the ­improved plate­let func­tions, desmo­pres­sin ­does not ­seem to ­have obvi­ous ben­e­fi­cial ­effects on post­op­er­a­tive hemo­sta­sis in ­patients with­out any bleed­ing dis­or­der and under­go­ing elec­tive car­diac sur­gery.

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