THE ROLE OF DESMOPRESSIN ACETATE IN PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-SURGERY - A CONTROLLED CLINICAL-TRIAL WITH THROMBOELASTOGRAPHIC RISK STRATIFICATION

The role of desmopressin acetate in attenuating blood loss and reducing homologous blood component therapy after cardiopulmonary bypass is unclear. The purpose of this investigation was to identify a subgroup of patients that may benefit from desmopressin acetate therapy. One hundred fifteen patients completed a prospective randomized double-blind, placebo-controlled trial designed to evaluate the effect of desmopressin acetate (0.3-mu-g.kg-1) on mediastinal chest tube drainage after elective coronary artery bypass grafting surgery in patients with normal and abnormal platelet-fibrinogen function as diagnosed by the maximal amplitude (MA) on thromboelastographic (TEG) evaluation. The 115 patients evaluated were divided into two groups based on the MA of the post-cardiopulmonary bypass TEG tracing. Group 1 (TEG:MA > 50 mm) consisted of 86 patients, of whom 44 received desmopressin and 42 received placebo. Twenty-nine patients had abnormal platelet function (TEG:MA < 50 mm) and were designated as group 2. In group 2, 13 received desmopressin and 16 placebo. During the first 24 h after cardiopulmonary bypass, the placebo-treated patients in group 2 had significantly greater mediastinal chest tube drainage when compared to placebo patients in group 1 (1,352.6 +/- 773.1 ml vs. 865.3 +/- 384.4 ml, P = 0.002). In addition to increases in blood loss, group 2 placebo patients also were administered an increased number of blood products (P < 0.05). The desmopressin-treated patients in group 2 neither experienced increased mediastinal chest tube drainage nor received increased amounts of homologous blood products when compared to those in group 1. There was a difference in mediastinal chest tube drainage between placebo and desmopressin patients in group 2 (1,352.6 +/- 773.1 vs. 881.2 +/- 594.6, P = 0.036). There were no differences in the postoperative complications that were evaluated. The results suggest that the TEG (TEG:MA < 50 mm) can identify a patient population at risk for increased mediastinal chest tube drainage. Desmopressin administered to those patients was effective in decreasing the volume of mediastinal chest tube drainage.