Randomized study of aprotinin and DDAVP to reduce postoperative bleeding after cardiopulmonary bypass surgery

Abstract

Background: Patients on cardiopulmonary bypass (CPB) have an increased susceptibility to postoperative bleeding. Previous reports using desmopressin acetate (DDAVP) for the prevention of postoperative bleeding have given contradictory results, whereas the protease inhibitor aprotinin has been shown to reduce blood loss after this type of surgery. This randomized study was performed to assess the efficacy of DDAVP versus aprotinin in the prevention of bleeding after CPB. Methods and Results: One hundred nine of 122 eligible patients were randomized to four different groups: Group A (n=28) received aprotinin starting with a bolus of 2 x 106 KIU followed by a continuous infusion of 0.5 x 106 KIU/h until the end of surgery; group B (n=25) received of DDAVP 0.3 μg/kg IV on completion of CPB; group C (n=28) received two doses of DDAVP, the first as in group B and an additional dose 6 hours after surgery; group D (n=28) received no treatment. There was a marked reduction of postoperative blood loss either at 12 hours (P