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document
Desmopressin has no beneficial effect on excessive postoperative bleeding or blood product requirements associated with cardiopulmonary bypass . Cardiopulmonary bypass during open-heart surgery is sometimes associated with excessive perioperative bleeding . Following a non-randomized study suggesting that desmopressin acetate ( desmopressin ) reduced blood product requirements in these patients , we conducted a double-blind , placebo-controlled randomized trial of desmopressin ( 0.3 micrograms/kg , i. v. ) in 92 patients with overt bleeding and a prolonged bleeding time . Mean blood loss during the first 24 h post-treatment was similar in the desmopressin and placebo groups ( 582 vs 465 ml , respectively ; p = 0.15 ) . Red-cell ( p = 0.76 ) , fresh frozen plasma ( r = 0.66 ) and platelet unit ( p = 0.74 ) requirements were also similar . The haemostatic effect of desmopressin has been attributed to the release of von Willebrand factor ( vWF ) and a reduced bleeding time . In our study , vWF and factor VIII : C levels increased while the bleeding time decreased significantly at 90 min and 24 h in both groups and , although vWF and factor VIII : C levels were slightly higher in desmopressin-treated patients at 90 min , the difference was not significant . Thrombin-antithrombin III complex , fibrinogen degradation product and tissue plasminogen activator levels , reflecting activation of the coagulation and fibrinolytic systems , respectively , decreased uniformly in both groups . We conclude that desmopressin is not useful in reducing blood loss or blood product requirements in patients with excessive immediate postoperative bleeding .
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Intervention_Pharmacological
Desmopressin
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Intervention_Pharmacological
desmopressin acetate ( desmopressin )
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Intervention_Control
placebo-controlled
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Intervention_Pharmacological
desmopressin
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Intervention_Pharmacological
desmopressin
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Intervention_Control
placebo
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Outcome_Physical
postoperative bleeding
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Outcome_Physical
perioperative bleeding
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Outcome_Physical
blood loss
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Outcome_Physical
bleeding time
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Outcome_Physical
vWF and factor VIII : C levels
14555
Outcome_Physical
bleeding time
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Outcome_Physical
vWF and factor VIII : C levels
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Outcome_Physical
Thrombin-antithrombin III complex
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Outcome_Other
,
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Outcome_Physical
fibrinogen degradation product
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Outcome_Other
and
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Outcome_Physical
tissue plasminogen activator levels
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Outcome_Physical
activation of the coagulation and fibrinolytic systems
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Outcome_Physical
blood loss or blood product requirements
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Participant_Condition
bleeding
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Participant_Condition
blood product requirements
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Participant_Condition
cardiopulmonary bypass
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Participant_Sample-size
92
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Participant_Condition
overt bleeding
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Participant_Condition
prolonged bleeding time