Patients With Severe Aortic Valve Stenosis and Impaired Platelet Function Benefit From Preoperative Desmopressin Infusion

• Published in: The Annals of thoracic surgery Vol. 91; no. 5; pp. 1420 - 1426
• Main Authors: Steinlechner, Barbara, MD, Zeidler, Petra, MD, Base, Eva, MD, Birkenberg, Beatrice, MD, Ankersmit, Hendrik Jan, MD, Spannagl, Michael, MD, Quehenberger, Peter, MD, Hiesmayr, Michael, MD, Jilma, Bernd, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2011; Elsevier
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Biological and medical sciences; Blood Platelet Disorders - diagnosis; Blood Platelet Disorders - mortality; Blood Platelet Disorders - surgery; Cardiology. Vascular system; Cardiothoracic Surgery; Deamino Arginine Vasopressin - administration & dosage; Double-Blind Method; Echocardiography, Doppler; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Hemostatics - administration & dosage; Hospital Mortality - trends; Humans; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Pneumology; Postoperative Hemorrhage - mortality; Postoperative Hemorrhage - prevention & control; Preoperative Care - methods; Reference Values; Risk Assessment; Severity of Illness Index; Surgery; Survival Analysis; Time Factors; Treatment Outcome; von Willebrand factor ristocetin cofactor; PFA-100; factor VIII activity; platelet function analyzer; 35; collagen adenosine diphosphate closure time; GpIb; VWF; DDAVP; VWF:RCo; VWF:CBA; VWF:Ag; CPB; von Willebrand factor; von Willebrand factor collagen-binding activity; cardiopulmonary bypass; FVIII:c; von Willebrand factor antigen; CADP-CT; glycoprotein receptor Ib; desmopressin; Human; Desmopressin; Aortic stenosis; Peptides; Cardiovascular disease; Patient; Infusion; Antidiuretic; Cardiac valvular disease; Neurohypophyseal hormone; Platelet function; Anesthesia; Circulatory system; Preoperative; Cardiology; Severe; Aortic valve
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2011.01.052

Background Patients with severe aortic valve stenosis have a markedly reduced platelet function as measured by a prolonged collagen adenosine diphosphate closure time (CADP-CT) determined by the platelet function analyzer PFA-100. We hypothesized that such patients may benefit from desmopressin when they present with prolonged CADP-CT due to the specific action of desmopressin on von Willebrand factor (VWF) and CADP-CT. Methods In this double-blind, randomized placebo controlled trial, 43 patients undergoing aortic valve replacement (due to severe aortic valve stenosis with CADP-CT > 170 seconds) were given desmopressin 0.3 μg/kg or saline intravenously after induction of anesthesia. Measurement of CADP-CT, factor VIII activity, von Willebrand factor antigen, GpIb binding activity, ristocetin cofactor activity, collagen-binding activity, and multimers were performed after induction of anesthesia, one hour after desmopressin infusion, and 24 hours postoperatively. Results In the majority of patients, baseline values of von Willebrand factor related indices were normal, but increased one hour after infusion of desmopressin by 73% to 90% as compared with placebo. Selective loss of high molecular weight multimers was seen only in a minority of patients. The CADP-CT was greater than 170 seconds in 92% of screened patients, and desmopressin shortened CADP-CT by 48% versus baseline and reduced postoperative blood loss by 42% ( p < 0.001). Conclusions Prolonged CADP-CT indicates platelet dysfunction in severe aortic valve stenosis, and can guide the use of desmopressin as an effective prohemostatic agent in patients with severe aortic valve stenosis.