Utilization and Effectiveness of Desmopressin Acetate After Cardiac Surgery Supplemented With Point-of-Care Hemostatic Testing: A Propensity-Score–Matched Analysis

Abstract

To explore the utilization pattern and hemostatic effectiveness of desmopressin acetate (DDAVP) supplemented with point-of-care (POC) hemostatic testing in contemporary cardiac surgery. Retrospective, observational study. Single quaternary care university hospital. The study comprised 2,468 consecutive patients undergoing cardiac surgery-1,237 before and 1,231 after the introduction of POC testing. The incidence of DDAVP administration during the year before (2012) and after (2013) the initiation of POC-based viscoelastic (ROTEM; Tem International GmBH, Munich, Germany) and platelet function (Plateletworks; Helena Laboratories, Beaumont, TX) testing was determined. Propensity-score matching was used to examine the association between DDAVP administration and major bleeding during each time period. DDAVP was administered more than twice as often after POC implementation (41% v 20%, p<0.001). Major bleeding was defined based on the universal definition of perioperative bleeding in adult cardiac surgery. Propensity matching identified 224 well-balanced pairs of DDAVP recipients and control patients before and 298 such pairs after the implementation of POC testing. After adjusting for matched data, DDAVP administration was associated with 1.70 (95% confidence interval 1.25-2.32, p<0.001) and 1.51 (95% confidence interval 1.15-1.98, p = 0.003) increases in the odds of major bleeding before and after the initiation of POC testing, respectively. Clinicians should be cognizant of the potential for increased use of DDAVP despite limited evidence of benefit in contemporary cardiac anesthesia practice supplemented with POC-based hemostatic testing.