Hemostatic Effects of Tranexamic Acid and Desmopressin During Cardiac Surgery

BACKGROUNDDesmopressin-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 therap...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1991-11, Vol.84 (5), p.2063-2070
Main Authors: Horrow, Jan C, Van Riper, Daniel F, Strong, Michael D, Brodsky, Isadore, Parmet, Jonathan L
Format: Article
Language:English
Subjects:
Biological and medical sciences
Blood Coagulation Tests
Blood Transfusion
Blood. Blood coagulation. Reticuloendothelial system
Cardiac Surgical Procedures
Deamino Arginine Vasopressin - administration & dosage
Deamino Arginine Vasopressin - therapeutic use
Double-Blind Method
Drug Therapy, Combination
Female
Hemostasis, Surgical - methods
Humans
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Tranexamic Acid - administration & dosage
Tranexamic Acid - therapeutic use
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Summary:BACKGROUNDDesmopressin-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 RESULTSA double-blinded design randomly allocated 163 adult patients undergoing coronary revascularization, valve replacement, both procedures, or repair of atrial septal defect to four treatment groupsplacebo, tranexamic acid given as 10 mg/kg over 30 minutes followed by 1 mg. kg. hr for 12 hours initiated before skin incision, desmopressin given as 0.3 μg/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%1 (mean, 318 versus 453 ml; CONCLUSIONSDesmopressin 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.
ISSN:0009-7322
1524-4539
DOI:10.1161/01.cir.84.5.2063