Effect of Desmopressin in Reducing Bleeding after Cardiac Surgery in Patients Receiving Anti-Platelet Agents

Kamran Shadvar ,Fatemeh Azizi ,Ata Mahmoodpoor ,Hadi Hamishehkar ,Bahman Naghipour ,Reza Movassaghi

doi:10.7575/aiac.abcmed.16.04.03.01

Abstract

Background : Severe bleeding is an important cause of morbidity and mortality in cardiac surgery using the cardiopulmonary bypass (CPB) pump. Desmopressin, a synthetic analogue of vasopressin, is used to prevent postoperative bleeding in patients with renal insufficiency. The aim of the present study was to evaluate the effect of desmopressin in reducing blood loss after cardiac surgery in patients receiving antiplatelet drugs. Methods: In this prospective clinical trial, 40 patients undergoing coronary artery bypass grafting (CABG) surgery with CPB, aged over 18 years, and on antiplatelet therapy for a week before surgery were divided in two groups. Case and control groups received nasal desmopressin spray and nasal normal saline spray, respectively. Patient vital signs, blood loss, administration of blood products, prescription drugs to improve the coagulation status, serum and whole intake and output of patients, need for a second surgery to control the bleeding, remaining sternum open, mortality due to bleeding, duration of intensive care unit (ICU) stay and mechanical ventilation were recorded. Results: In the case and control groups there were no differences in duration of operation, mechanical ventilation and length of ICU stay. There was no significant difference in terms of postoperative bleeding and intake of blood products between two groups ( P >0.05). Reoperation due to bleeding in the case and control groups was observed in 3 (15%), and 1 (5%) patient(s), respectively ( P =0.3). Conclusion: Desmopressin has no significant effect on reducing the amount of bleeding after cardiac surgery in patients receiving anti-platelet agents. Keywords: CABG; cardio pulmonary bypass pump; hemorrhage; desmopressin

Highlights

In recent years, there has been a significant progress in cardiac surgery and mortality rate has been reduced due to improvement in anesthetic and surgical techniques and patient care either in operating room or in later stages of the operation
According to the increasing number and extent of heart surgery, most blood products are used in cardiac surgery wards
The use of cardiopulmonary bypass (CPB) in cardiac surgery, amount of heparin used to prevent clotting in the CPB circuit, extent of heart surgery and performing heart surgery for the second, third and even fourth time all lead to hemostasis and coagulation disorders and increased bleeding during and after surgery

Summary

Introduction

There has been a significant progress in cardiac surgery and mortality rate has been reduced due to improvement in anesthetic and surgical techniques and patient care either in operating room or in later stages of the operation. Desmopressin (1-desamino-8-D-arginine vasopressin) is a synthetic vasopressin analogue used in patients with diabetes insipidus as well as in patients with hemophilia A and Von Willebrand disease [8, 9] This drug is used to prevent postoperative bleeding in patients with renal failure and improves platelet function and increases factor VIII and Von Willebrand factor [9,10,11,12,13,14,15]. The aim of the present study was to evaluate the effect of desmopressin in reducing blood loss after cardiac surgery in patients receiving antiplatelet drugs. Conclusion: Desmopressin has no significant effect on reducing the amount of bleeding after cardiac surgery in patients receiving anti-platelet agents

Objectives

Methods

Results

Conclusion