Adventures in hemostasis. Desmopressin in cardiac surgery
E. W. Salzman, M. J. Weinstein, D. Reilly and J. A. Ware
Department of Surgery, Beth Israel Hospital, Boston, MA 02215.
Desmopressin acetate (1-deamino-8-D-arginine vasopressin [DDAVP]) improves
hemostasis in hemophilia A and von Willebrand's disease and in some
platelet disorders. In complex cardiac operations, excluding simple
coronary artery bypass graft procedures, we found that desmopressin reduced
blood loss by 40% and the need for transfusion by 34%. Conflicting reports
followed. Future trials should emphasize patients with excessive bleeding.
A possible post-desmopressin prothrombotic state was studied after hip
replacement surgery. The incidence of deep vein thrombosis associated with
warfarin sodium therapy was the same as that associated with desmopressin
plus warfarin therapy. No desmopressin-induced thrombotic tendency was
detected. A trend toward reduced blood loss with desmopressin was not
significant. During cardiac catheterization, the plasma von Willebrand
factor level was correlated with hemodynamic variables, including pulmonary
vascular resistance, pulmonary arterial pressure, and (inversely) with
cardiac index. von Willebrand factor concentration was highest in mitral
stenosis. The relationship of these factors to the response to desmopressin
remains to be defined.
