Does tranexamic acid reduce desmopressin-induced hyperfibrinolysis?

Abstract

Objective: Desmopressin releases tissue-type plasminogen activator, which augments cardiopulmonary bypass-associated hyperfibrinolysis, causing excessive bleeding. Combined use of desmopressin with prior administration of the antifibrinolytic drug tranexamic acid may decrease fibrinolytic activity and might improve postoperative hemostasis. Methods: This prospective randomized study was carried out with 100 patients undergoing coronary artery bypass operations between April 1999 and November 2000 in Gülhane Military Medical Academy. Patients were divided into 2 groups. Desmopressin (0.3 μg/kg) was administrated just after cardiopulmonary bypass and after protamine infusion in group 1 (n = 50). Both desmopressin and tranexamic acid (before the skin incision at a loading dose of 10 mg/kg over 30 minutes and followed by 12 hours of 1 mg·kg-1·h-1) were administrated in group 2 (n = 50). Results: Significantly less drainage was noted in group 2 (1010 ± 49.9 mL vs 623 ± 41.3 mL, P = .0001). Packed red blood cells were transfused at 2.1 ± 0.5 units per patient in group 1 versus 0.9 ± 0.3 units in group 2 (P = .0001). Fresh frozen plasma was transfused at 1.84 ± 0.17 units per patient in group 1 versus 0.76 ± 0.14 units in group 2 (P = .0001). Only 24% of patients in group 2 required donor blood or blood products compared with 74% of those in the isolated desmopressin group (group 1, P = .00001). Group 1 and group 2 findings were as follows: postoperative fibrinogen, 113 ± 56.3 mg/dL versus 167 ± 45.8 mg/dL (P = .0001); fibrin split product, 21.2 ± 2.3 ng/mL versus 13.5 ± 3.4 ng/mL (P = .0001); and postoperative hemoglobin level, 7.6 ± 1.2 g/dL versus 9.1 ± 1.2 g/dL (P = .0001). Conclusion: Tranexamic acid administration significantly reduces desmopressin and bypass-induced hyperfibrinolysis. Combined use of tranexamic acid and desmopressin decreases both postoperative blood loss and transfusion requirement.