THE EFFECT OF DESMOPRESSIN ON REDUCING BLOOD-LOSS IN CARDIAC-SURGERY - A METAANALYSIS OF DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALS

The effect of desmopressin (DDAVP) on reducing postoperative blood los s after cardiac surgery has been studied in several randomized clinica l trials, with conflicting outcomes. Since most trials had insufficien t statistical power to detect true differences in blood loss, we perfo rmed a meta-analysis of data from relevant studies. Seventeen randomiz ed, double-blind, placebo-controlled trials were analyzed, which inclu ded 1171 patients undergoing cardiac surgery for various indications 5 79 of them were treated with desmopressin and 592 with placebo. Effica cy parameters were blood loss volumes and transfusion requirements. De smopressin significantly reduced postoperative blood loss by 9%, but h ad no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in tr ials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in place bo-treated patients fell in the upper third of distribution (>1109 ml/ 24 h), desmopressin significantly decreased postoperative blood loss b y 34%. Insufficient data were available to perform a sub-analysis on t ransfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood lo ss. Further studies are called to validate the results of this meta-an alysis and to identify predictors of excessive blood loss after cardia c surgery.