Supervisors info:
Ωραιάνθη Τραυλού, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Σερένα Βαλσάμη, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Ευφροσύνη Μερκούρη, Επιστημονικός Συνεργάτης, Ιατρική, ΕΚΠΑ
Summary:
Peri-operative bleeding and the need for blood tranfusions are correlated with increased morbidity, mortality, and cost. Among the pharmacological options to control bleeding are desmopressin (1-deamino-8-D-arginine vasopresin, DDAVP) and tranexamic acid. These drugs are cost effective but the knowledge regarding their
simultaneous use is limited.
The tranexamic acid is antifibrinolytic agent, while desmopressin improve primary and secondary hemostasis. The purpose of this study was to determine the efficiency and safety of these drugs in cardiac surgical patients, pre-treated with these hemostatic agents. All the patients were on residual antiplatelet activity of clopidogrel.
25 patients aged 18 years or more undergoing elective cardiac surgery were enrolled in this study. Tranexamic (20 mg/kgr) at the induction of anesthesia and desmopressin (0, 3γ/kgr) after the heparinization of the patient, tranexamic (10 mg/kgr) during CPB and desmopressin (0, 3γ/kgr) with tranexamic (30mg/kgr) after
the neutralization of heparine with protamine sulfate, were administered.
We studied for 7 days the clinical status of the patients, the blood gas analysis, laboratory-based hematological and biochemistry tests, ECG’s, thromboelastographic results, classical hemorrhagic tests, the urine and blood output and the temperature trend.
We focused on searching adverse events, such as antidiuresis, hypotension, hyponatriaemia, kidney malfunction or failure, seisures, cardiac ischemia or infarction and thrombosis.
We found that the bleeding control was good, without increase in fibrinolysis, there was not hyponatraemia or creatinine increase and all the other tests were normal.
No major adverse events was present. The haemodynamic instability was managed with vasoactive drugs.
In conclusion, the use of desmopressin together with tranexamic acid for the control of bleeding is effective and safe in cardiac surgery patients, with the use of cardiopulmonary bypass.
