9Pharmacological agents: antifibrinolytics and desmopressin
Section snippets
Antifibrinolytics: lysine analogues
Aprotinin has been used for 20 years in cardiac surgery and liver transplantation. Its blood-sparing efficacy has been widely recognised and many deemed the drug essential in high-risk procedures. Meta-analyses of RCTs were reassuring with regard to safety issues. In October 2007 were released the preliminary findings of the Canadian trial titled Blood Conservation Using Antifibrinolytics in a Randomised Trial (BART). The interim analysis of the BART trial results pointed to a strong and
In cardiopulmonary bypass surgery
It is widely accepted that non-operative blood loss after CPB mainly results from a combination of excessive fibrinolysis and an acquired platelet dysfunction. Consequently, attempts have been made to reduce blood loss by the prophylactic use of antifibrinolytic drugs. In addition to inhibiting fibrinolysis, lysine analogues may lessen plasmin-induced platelet activation, consequently preserving platelet function.
Desmopressin
Desmopressin acetate (1-deamino-8-d-arginine vasopressin or dDAVP) is a synthetic analogue of the antidiuretic hormone arginine vasopressin that was initially devoted to the treatment of central diabetes insipidus. Through a direct action on endothelial V2 receptors, desmopressin raises factor VIII and von Willebrand factor (vWF) plasma concentrations in healthy volunteers. The increase in vWF concentrations is related to a release from endothelial intracellular storage sites and not to de novo
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