Abstract
A previous study has found that desmopressin (DDAVP), which releases factor VIII/von Willebrand factor from vascular endothelium, significantly reduces blood loss after complicated cardiac bypass surgery. To determine whether or not desmopressin reduces blood loss or transfusion requirements after routine coronary artery bypass surgery, we randomized 100 patients to receive, double-blind, either desmopressin (0.3 μg/kg over 30 minutes intravenously) or placebo at the end of cardiopulmonary bypass. The two groups were similar in age, sex, prior aspirin use and number of coronary grafts. Following desmopressin infusion, factor VIII coagulant activity was higher than in the placebo group (117 ± 31 versus 95 ± 48 iu/dl, p < 0.05) as was von Willebrand factor antigen (141 ± 53 versus 114 ± 40 iu/dl, p < 0.01). No significant changes in fibrinolysis (fibrin plate lysis area) were observed in either group. Despite this haemostatic effect, patients treated with desmopressin had similar postoperative blood loss to the placebo group (1029 ± 523 versus 976 ± 441 ml) and similar blood transfusion requirements (67.5 units in 33 patients versus 63.5 units in 35 patients). There were no significant differences between groups in the incidence of complications, including postoperative hyponatraemia. We conclude that desmopressin is not useful in reducing blood loss after routine, uncomplicated coronary artery bypass surgery.
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