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Desmopressin in Cardiac Surgery

Edwin W. Salzman, MD; Mark J. Weinstein, PhD; Donald Reilly, MD; J. Anthony Ware, MD

Arch Surg. 1993;128(2):212-217.

Abstract
• 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 postdesmopressin 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.

(Arch Surg. 1993;128:212-217)

Author Affiliations
From Beth Israel Hospital (Drs Salzman and Ware), Boston University School of Medicine (Dr Weinstein), Brigham & Women's Hospital (Dr Reilly), and Harvard Medical School (Drs Salzman, Ware, and Reilly), Boston, Mass.

Footnotes
Accepted for publication July 25, 1992.

Presented at a meeting in honor of the 25th anniversary of William Silen, MD, as Chief of Surgery at Beth Israel Hospital, Boston, Mass, May 16, 1991.

Reprint requests to Department of Surgery, Beth Israel Hospital, 330 Brookline Ave, Boston, MA 02215 (Dr Salzman).

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