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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 117-123, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J Ansell, V Klassen, R Lew, S Ball, M Weinstein, T VanderSalm, N Okike, I Gratz, J Leslie and A Roberts
The effectiveness of prophylactic desmopressin acetate in reducing
hemorrhage after cardiopulmonary bypass operations is controversial. We
conducted a prospective, randomized, placebo-controlled, double-blind trial
to determine its effectiveness and safety in such patients. Eighty-three
evaluable patients undergoing valvular heart operations were randomized to
receive desmopressin (0.3 microgram/kg) (41) or placebo (42) after cardiac
bypass. Demographic characteristics were similar in both groups. There was
no significant difference in total 24- hour blood loss between groups
(desmopressin 1064.8 +/- 647.1 ml versus placebo 844.4 +/- 507.6 ml; p
greater than 0.05), or in the requirement for red blood cell, platelet, or
fresh frozen plasma transfusion, or for reexploration for control of
hemorrhage. Neither was there a difference in the occurrence of thrombotic
complications between groups. Analysis of factor VIII activity, von
Willebrand factor, or von Willebrand factor multimers failed to show
significant correlations with blood loss or differences between groups
except for factor VIII activity, which was significantly higher in the
desmopressin group 1 hour after operation than in the placebo group. A
detailed comparative analysis of similar trials to determine the reasons
for different outcomes suggests that desmopressin should not be used
routinely as a prophylactic agent to reduce postsurgical hemorrhage, but
that it may be beneficial when used in patients who already manifest
excessive bleeding postoperatively.
ARTICLES
Does desmopressin acetate prophylaxis reduce blood loss after valvular heart operations? A randomized, double-blind study
University of Massachusetts Medical School, Worcester.
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