Effects of Prophylactic Desmopressin on Blood Coagulation Parameters in Heart Valve Surgery

Placebo-Controlled, Randomized, Double-Blind Trial of Prophylactic Desmopressin in Heart Valve Surgery

The purpose of this study is evaluate the effect of prophylactic desmopressin on blood coagulation parameters and postoperative bleeding in patients undergoing valve cardiac surgery with cardiopulmonary bypass.

Patients with important valve disorders may evaluate with coagulopathy induced by mechanical effects (valvular stenosis or valvular insufficiency). Furthermore, frequently is required prophylactic use of antiplatelet drugs due to myocardial remodeling and antiarrhythmic conditions that may be associated. Patients with severe aortic stenosis may also acquired von Willebrand disease type 2A due to proteolysis of vonWillebrand factor. Despite of this, the treatment of valve disorders often requires cardiac surgery with cardiopulmonary bypass. On average 50 to 60% of patients undergoing cardiac surgery receive blood tranfusions. Blood cell transfusion is an independent risk factor for increased morbidity and mortality in critically ill patients. The use of desmopressin seems beneficial only in patients with congenital or acquired platelet dysfunction. In general population, such use is not validated due to inconclusive results of researches.

Inclusion Criteria:

• Valve cardiac surgery with cardiopulmonary bypass.
• Written informed consent

Exclusion Criteria:

• Reoperative valve surgery
• Hematocrit < 35%
• Ventricular dysfunction (EF < 40%)
• Infection
• Body mass index > 35
• Renal impairment (Creatinin > 2mg/dL)
• Antiplatelet administration within 10 days preceding study surgery
• Participation in another interventional clinical study within 30 days
• Known or suspected hypersensitivity to the desmopressin
• Coagulopathy (INR > 1.5)