Circulation, Vol 84, 2063-2070, Copyright © 1991 by American Heart Association
JC Horrow, DF Van Riper, MD Strong, I Brodsky and JL Parmet
BACKGROUND. Desmopressin-induced release of tissue plasminogen activator
from endothelial cells may explain the absence of its hemostatic effect in
patients undergoing cardiac surgery. Prior administration of the
antifibrinolytic drug tranexamic acid might unmask such an effect, and
combination therapy might thereby improve postoperative hemostasis. METHODS
AND RESULTS. A double-blinded design randomly allocated 163 adult patients
undergoing coronary revascularization, valve replacement, both procedures,
or repair of atrial septal defect to four treatment groups: placebo,
tranexamic acid given as 10 mg/kg over 30 minutes followed by 1
mg.kg-1.hr-1 for 12 hours initiated before skin incision, desmopressin
given as 0.3 micrograms/kg over 20 minutes after protamine infusion, and
both drugs. One surgeon performed all operations. Blood loss consisted of
mediastinal tube drainage over 12 hours. Follow-up visits sought evidence
of myocardial infarction and stroke. Desmopressin decreased neither the
12-hour blood loss nor the amount of homologous red cells transfused.
Tranexamic acid alone significantly reduced 12-hour blood loss, by 30%
(mean, 318 versus 453 ml; p less than 0.0001), without enhancement by
desmopressin. Tranexamic acid also decreased the proportion of patients
receiving homologous blood within 12 hours of operation (8% versus 21%, p =
0.024) and within 5 days of operation (22% versus 41%, p = 0.011).
CONCLUSIONS. Desmopressin exerts no hemostatic effect, with or without
prior administration of antifibrinolytic drug. Prophylactic tranexamic acid
alone appears economical and safe in decreasing blood loss and transfusion
requirement after cardiac surgery.
ARTICLES
Hemostatic effects of tranexamic acid and desmopressin during cardiac surgery
Division of Cardiothoracic Anesthesia (Department of Anesthesiology), Hahnemann University, Philadelphia, PA 19101-1192.
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