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J Thorac Cardiovasc Surg 2002;123:539-543
© 2002 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CSP)

Does tranexamic acid reduce desmopressin-induced hyperfibrinolysis?

Erturul Özal, MD, Erkan Kuralay, MD, Hakan Bingöl, MD, Faruk Cingöz, MD, Süleyman Ceylan, MD, Harun Tatar, MD

From the Gülhane Military Medical Academy Cardiovascular Surgery Department Etlik, Ankara, Turkey.

Received for publication Feb 6, 2001; revisions requested March 21, 2001; revisions received April 6, 2001; accepted for publication May 14, 2001. Address for reprints: Erturul Özal, MD, GATA Lojmanlari Pamir Apt. No:15, Etlik, Ankara, Turkey 06010 (E-mail: ozal{at}tr.net).

Objective: Desmopressin releases tissue-type plasminogen activator, which augments cardiopulmonary bypass–associated hyperfibrinolysis, causing excessive bleeding. Combined use of desmopressin with prior administration of the antifibrinolytic drug tranexamic acid may decrease fibrinolytic activity and might improve postoperative hemostasis.
Methods: This prospective randomized study was carried out with 100 patients undergoing coronary artery bypass operations between April 1999 and November 2000 in Gülhane Military Medical Academy. Patients were divided into 2 groups. Desmopressin (0.3 µg/kg) was administrated just after cardiopulmonary bypass and after protamine infusion in group 1 (n = 50). Both desmopressin and tranexamic acid (before the skin incision at a loading dose of 10 mg/kg over 30 minutes and followed by 12 hours of 1 mg·kg^-1·h^-1) were administrated in group 2 (n = 50).
Results: Significantly less drainage was noted in group 2 (1010 ± 49.9 mL vs 623 ± 41.3 mL, P = .0001). Packed red blood cells were transfused at 2.1 ± 0.5 units per patient in group 1 versus 0.9 ± 0.3 units in group 2 (P = .0001). Fresh frozen plasma was transfused at 1.84 ± 0.17 units per patient in group 1 versus 0.76 ± 0.14 units in group 2 (P = .0001). Only 24% of patients in group 2 required donor blood or blood products compared with 74% of those in the isolated desmopressin group (group 1, P = .00001). Group 1 and group 2 findings were as follows: postoperative fibrinogen, 113 ± 56.3 mg/dL versus 167 ± 45.8 mg/dL (P = .0001); fibrin split product, 21.2 ± 2.3 ng/mL versus 13.5 ± 3.4 ng/mL (P = .0001); and postoperative hemoglobin level, 7.6 ± 1.2 g/dL versus 9.1 ± 1.2 g/dL (P = .0001).
Conclusion: Tranexamic acid administration significantly reduces desmopressin and bypass-induced hyperfibrinolysis. Combined use of tranexamic acid and desmopressin decreases both postoperative blood loss and transfusion requirement.

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