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Changes in von Willebrand factor during cardiac surgery: effect of
desmopressin acetate
M Weinstein, JA Ware, J Troll and E Salzman
William B. Castle Hematology Research Laboratory, Department of Medicine,
Boston City Hospital, MA 02118.
Patients who receive desmopressin acetate (dDAVP) after cardiopulmonary
bypass bleed less during operation and in the first 24 hours after
operation than do patients who receive a placebo. To study the mechanism of
improved hemostasis in bypass patients, we examined the relationship
between von Willebrand factor (vWF) and blood loss in 70 cardiopulmonary
bypass patients, one-half of whom received desmopressin intraoperatively.
vWF concentration and multimeric composition were analyzed before and after
bypass, after drug treatment, and 24 hours after operation. Before
operation, patients with valvular disease had lower percentages of vWF
high-mol-wt multimers (HMWMs) than did healthy subjects or patients with
coronary artery disease, but subsequent blood loss, vWF activity, and
bleeding times were not related to this finding. Irrespective of drug
treatment, patients who had low preoperative vWF and who had a net loss of
the protein during bypass bled more after bypass than did similar patients
who had a net increase of vWF during bypass. HMWMs rose to above normal
levels after bypass regardless of desmopressin infusion. Differences in the
concentration of vWF between desmopressin and placebo patients after
receipt of the drug, although small, were better correlated with reduced
blood loss than were differences in HMWM distribution. We conclude that the
beneficial effect of desmopressin on hemostasis following cardiopulmonary
bypass cannot be attributed to a drug-induced change in HMWM distribution
but may be related to an increase in overall vWF concentration.
Volume 71,
Issue 6,
pp. 1648-1655,
06/01/1988
Copyright © 1988 by The American Society of Hematology
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