Use of point-of-care test in identification of patients who can benefit from desmopressin during cardiac surgery: a randomised controlled trial

Background Platelet dysfunction is a major cause of excessive microvascular bleeding after cardiac surgery. A new point-of-care test (hemoSTATUS) can identify patients at risk of excessive bleeding. We aimed to find out wheth er patients who can benefit from desmopressin during cardiac surgery can be identified by this test. Methods We enrolled 203 patients scheduled for elective cardiac surgery in a prospective, double-blind, placebo-controlled trial. Patients with abnorm al hemoSTATUS clot-ratio results (<60% of maximum in channel 5) after disco ntinuation of cardiopulmonary bypass were randomly assigned desmopressin (n =50) or placebo (n=51). Patients with normal clot ratios were included in a n untreated control group (n=72). Findings Intraoperative platelet counts and clot ratios were significantly higher in the untreated control group than in the study-drug groups. In int ensive care, clot ratios in patients who received desmopressin were similar to those in the untreated control group, despite significantly lower plate let counts, but were lower in the placebo group than in the other two group s (p=00001). Compared with the placebo group, patients who received desmopr essin had less blood loss in 24 h (mean 624 [SD 209] vs 1028 mt [682] p=0.0 004) and required less transfusion of red blood cells (1.1[022] vs 2.2 U [0 .32] p=0.009), platelets (0.1 [0.04] vs 1.9 U [4.5] p=0.0001), and fresh-fr ozen plasma (0.1[0.07] vs 0.75 U [0.21] p=0.0008), and had less total blood -donor exposures (1.56 [0.31] vs 5.2 [0.8] p=0.0001). Placebo patients also had substantially higher blood loss and transfusion requirements than untr eated control patients. Interpretation Patients identified with hemoSTATUS as being at increased ri sk of excessive bleeding after cardiac surgery can benefit from administrat ion of desmopressin. Further studies are, however, needed to confirm these findings as well as to identify the mechanism of action and safety of desmo pressin in the clinical setting.