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CARDIOVASCULAR ANESTHESIA

Prophylactic Treatment with Desmopressin Does Not Reduce Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Before Surgery

Hilde Pleym, MD^*, Roar Stenseth, MD PhD^*, Alexander Wahba, MD PhD, Lise Bjella, MD^*, Arve Tromsdal, MD, Asbjørn Karevold, MD, and Ola Dale, MD PhD^*,

Departments of *Anesthesiology and Cardiothoracic Surgery, St. Olav University Hospital; and Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

Address correspondence and reprint requests to Hilde Pleym, MD, St. Elisabeth Department of Cardiothoracic Surgery, Hans Nissens gate 3, N-7018 Trondheim, Norway. Address e-mail to hilde.pleym{at}stolav.no

The synthetic vasopressin analog desmopressin has hemostatic properties and may reduce postoperative bleeding after coronary artery bypass grafting (CABG). A study on the effects of recent aspirin ingestion on platelet function in cardiac surgery showed a greater impairment of platelet function in patients treated with aspirin <2 days before the operation. We evaluated the effects of desmopressin on postoperative bleeding in CABG patients who were treated with aspirin 75 or 160 mg until the day before surgery. The study was a prospective, randomized, double-blinded, placebo-controlled, parallel group trial. One-hundred patients were included and divided into two groups. One group received desmopressin 0.3 µg/kg and the other received placebo (0.9% NaCl) after the neutralization of heparin with protamine sulfate. Postoperative blood loss was recorded for 16 h. The mean (SD) bleeding was 606 (237) mL in the desmopressin group and 601 (301) mL in the placebo group (P = 0.93), representing no significant difference (95% confidence interval, -107 to 117 mL). We conclude that desmopressin does not reduce postoperative bleeding in CABG patients treated with aspirin until the day before surgery.

IMPLICATIONS: Continuation of aspirin until the day before coronary artery bypass grafting may increase postoperative bleeding. The administration of desmopressin to these patients after the neutralization of heparin with protamine sulfate does not reduce postoperative bleeding.

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