Effect of Desmopressin in Reducing Bleeding after Cardiac Surgery in Patients Receiving Anti-Platelet Agents

Kamran Shadvar, Fatemeh Azizi, Ata Mahmoodpoor, Hadi Hamishehkar, Bahman Naghipour, Reza Movassaghi


Background: Severe bleeding is an important cause of morbidity and mortality in cardiac surgery using the cardiopulmonary bypass (CPB) pump. Desmopressin, a synthetic analogue of vasopressin, is used to prevent postoperative bleeding in patients with renal insufficiency. The aim of the present study was to evaluate the effect of desmopressin in reducing blood loss after cardiac surgery in patients receiving antiplatelet drugs. Methods: In this prospective clinical trial, 40 patients undergoing coronary artery bypass grafting (CABG) surgery with CPB, aged over 18 years, and on antiplatelet therapy for a week before surgery were divided in two groups. Case and control groups received nasal desmopressin spray and nasal normal saline spray, respectively. Patient vital signs, blood loss, administration of blood products, prescription drugs to improve the coagulation status, serum and whole intake and output of patients, need for a second surgery to control the bleeding, remaining sternum open, mortality due to bleeding, duration of intensive care unit (ICU) stay and mechanical ventilation were recorded. Results: In the case and control groups there were no differences in duration of operation, mechanical ventilation and length of ICU stay. There was no significant difference in terms of postoperative bleeding and intake of blood products between two groups (P>0.05). Reoperation due to bleeding in the case and control groups was observed in 3 (15%), and 1 (5%) patient(s), respectively (P=0.3). Conclusion: Desmopressin has no significant effect on reducing the amount of bleeding after cardiac surgery in patients receiving anti-platelet agents.


Keywords: CABG; cardio pulmonary bypass pump; hemorrhage; desmopressin


Full Text:



Miller RD, Fleisher LA, Johns RA, Savarese JJ, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. Philadelphia: Churchill Livingstone; 2005.

Despotis GJ, Goodnough LT. Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery. Ann Thorac Surg. 2000;70(2 Suppl):S20-S32.

Horrow JC, Van Riper DF, Strong MD, Brodsky I, Parmet JL. Hemostatic effects of tranexamic acid and desmopressin during cardiac surgery. Circulation. 1991;84(5):2063-70.

Lethagen S, Rugarn P, Bergqvist D. Blood loss and safety with desmopressin or placebo during aorto-iliac graft surgery. Eur J Vasc Surg. 1991;5(2):173-8.

Pleym H, Wahba A, Videm V, Asberg A, Lydersen S, Bjella L, Dale O, Stenseth R. Increased fibrinolysis and platelet activation in elderly patients undergoing coronary bypass surgery. Anesth Analg. 2006;102(3):660-7.

Harker LA, Malpass TW, Branson HE, Slichter S. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: acquired transient platelet dysfunction associated with selective alpha-granule release. Blood. 1980;56(5):824-34.

Parolari A, Guarnieri D, Alamanni F, Toscano T, Tantalo V, Gherli T, Colli S, Foieni F, Franzè V, Stanghellini M, Gianotti GA, Biglioli P, Tremoli E. Platelet function and anesthetics in cardiac surgery: an in vitro and ex vivo study. Anesth Analg. 1999;89(1):26-31.

Shiffrin JS, Glass DD. Pro: desmopressin is of value in the treatment of post-cardiopulmonary bypass bleeding. J Cardiothorac Vasc Anesth. 1991;5(3):285-9.

Mannucci PM. Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years. Blood. 1997;90(7):2515-21.

Andersson T, Solem JO, Tengborn L, Vinge E. Effects of desmopressin acetate on platelet aggregation, von Willebrand factor, and blood loss after cardiac surgery with extracorporeal circulation. Circulation. 1990;81(3):872-8.

Despotis GJ, Levine V, Saleem R, Spitznagel E, Joist JH. Use of point-of-care test in identification of patients who can benefit from desmopressin during cardiac surgery: a randomised controlled trial. Lancet. 1999;354(9173):106-10.

Raja SG, Shahbaz Y. Desmopressin for haemostasis in cardiac surgery: when to use? Ann Card Anaesth. 2006;9(2):102-7.

Salmenperä M, Kuitunen A, Hynynen M, Heinonen J. Hemodynamic responses to desmopressin acetate after CABG: a double-blind trial. J Cardiothorac Vasc Anesth. 1991;5(2):146-9.

Weber CF, Dietrich W, Spannagl M, Hofstetter C, Jámbor C. A point-of-care assessment of the effects of desmopressin on impaired platelet function using multiple electrode whole-blood aggregometry in patients after cardiac surgery. Anesth Analg. 2010;110(3):702-7.

Weinstein M, Ware JA, Troll J, Salzman E. Changes in von Willebrand factor during cardiac surgery: effect of desmopressin acetate. Blood. 1988;71(6):1648-55.

Despotis GJ, Hogue Jr CW. Pathophysiology, prevention, and treatment of bleeding after cardiac surgery: a primer for cardiologists and an update for the cardiothoracic team. Am J Cardiol. 1999;83(4):15-30.

Milas BL, Jobes DR, Gorman RC. Management of bleeding and coagulopathy after heart surgery. Semin Thorac Cardiovasc Surg. 2000;12(4):326-36.

Cook DJ. Changing temperature management for cardiopulmonary bypass. Anesth Analg. 1999;88(6):1254-71.

Valeri CR, Feingold H, Cassidy G, Ragno G, Khuri S, Altschule MD. Hypothermia-induced reversible platelet dysfunction. Ann Surg. 1987;205(2):175-81.

Temeck BK, Bachenheimer LC, Katz NM, Coughlin SS, Wallace RB. Desmopressin acetate in cardiac surgery: a double-blind, randomized study. South Med J. 1994;87(6):611-5.

Brown MR, Swygert TH, Whitten CW, Hebeler R. Desmopressin acetate following cardiopulmonary bypass: Evaluation of coagulation parameters. J Cardiothorac Anesth. 1989;3(6):726-9.

Marquez J, Koehler S, Strelec SR, Benckart DH, Spero JA, Cottington EM, Torpey DJ Jr. Repeated dose administration of desmopressin acetate in uncomplicated cardiac surgery: a prospective, blinded, randomized study. J Cardiothorac Vasc Anesth. 1992;6(6):674-6.

Salzman EW, Weinstein MJ, Weintraub RM, Ware JA, Thurer RL, Robertson L, Donovan A, Gaffney T, Bertele V, Troll J, et al. Treatment with desmopressin acetate to reduce blood loss after cardiac surgery. A double-blind randomized trial. N Engl J Med. 1986;314(22):1402-6.

Dilthey G, Dietrich W, Spannagl M, Richter JA. Influence of desmopressin acetate (DDAVP) on homologous blood requirement in cardiac surgical patients pretreated with platelet-inhibiting drugs. J Cardiothorac Vasc Anesth. 1993;7(4):425-30.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.

Advances in Bioscience and Clinical Medicine