The Effect of Desmopressin on Reducing Blood Loss in Cardiac Surgery – A Meta-Analysis of Double-Blind, Placebo-Controlled Trials

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials 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 placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

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Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Perfusion ◽

10.1177/0267659116685418 ◽

2017 ◽

Vol 32 (5) ◽

pp. 350-362 ◽

Cited By ~ 6

Author(s):

Idris Ghijselings ◽

Dirk Himpe ◽

Steffen Rex

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Blood Loss ◽

Meta Analysis ◽

Postoperative Bleeding ◽

Postoperative Blood Loss ◽

Transfusion Requirements ◽

Significant Difference ◽

Secondary Outcomes

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

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Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1691748 ◽

2019 ◽

Vol 68 (03) ◽

pp. 212-218

Author(s):

Louay M. Habbab ◽

Lloyd Semelhago ◽

André Lamy

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Tranexamic Acid ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Secondary Outcome ◽

Controlled Trials ◽

Complication Rates ◽

Randomized Controlled ◽

Transfusion Requirements

Abstract Background This meta-analysis was conducted to investigate the evidence for the efficacy and safety of intrapericardial tranexamic acid (TXA) in cardiac surgery. Methods We searched MEDLINE from 2000 to 2017 for randomized controlled trials that compared intrapericardial TXA to placebo. We performed a meta-analysis for the eligible trials that focused on chest tube drainage measured during the first 24 hours after surgery as a primary outcome. We also examined the secondary outcome measures of these trials such as the incidence of transfusion requirements following surgery and the evidence for any increase in complication rates. Results A total of seven randomized controlled trials (six on-pump and one off-pump) comparing topical application of TXA to placebo in 692 patients were eligible for the blood loss outcome data. These trials randomized 372 patients to receive TXA and 320 patients as controls. The use of intrapericardial TXA was associated with a considerable reduction in 24-hour blood loss in all seven studies and a weighted mean difference of −343.56 mL (95% confidence interval: −316.41, −370.72) significantly differed from zero (p = 0.005) with a heterogeneity of I 2 = 0%. The incidence of packed RBC transfusion in TXA patients was significantly lower in one study and was not significant but with trend in favor of TXA in five out of the six studies in which it was reported. In one trial, TXA was not detected in any patient and in another the studied groups were similar in postoperative complications, such as graft patency, myocardial infarction, cerebral infarction, atrial fibrillation, seizures, and infections. Conclusions Findings from this meta-analysis suggest that intrapericardial use of TXA in patients undergoing cardiac surgery can decrease postoperative bleeding without increasing the risk of postoperative seizures. Future large randomized, double-blind, controlled clinical trials are needed to confirm these promising findings.

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High-dose Aprotinin in Cardiac Surgery—A Prospective, Randomized Study

Anaesthesia and Intensive Care ◽

10.1177/0310057x9402200505 ◽

1994 ◽

Vol 22 (5) ◽

pp. 529-533 ◽

Cited By ~ 20

Author(s):

M. J. Swart ◽

P. C. Gordon ◽

P. B. Hayse-Gregson ◽

R. A. Dyer ◽

A. L. Swanepoel ◽

...

Keyword(s):

Cardiac Surgery ◽

Placebo Group ◽

Blood Loss ◽

Artery Bypass ◽

Randomized Study ◽

Postoperative Blood Loss ◽

High Dose ◽

Maintenance Infusion ◽

Transfusion Requirements ◽

High Dose Aprotinin

Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 units/hr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95% confidence interval (CI) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.

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Impact of maternal supplementation with probiotics during pregnancy on atopic eczema in childhood – a meta-analysis

British Journal Of Nutrition ◽

10.1017/s0007114511003400 ◽

2011 ◽

Vol 107 (1) ◽

pp. 1-6 ◽

Cited By ~ 77

Author(s):

Katja Doege ◽

Donata Grajecki ◽

Birgit-Christiane Zyriax ◽

Elena Detinkina ◽

Christine zu Eulenburg ◽

...

Keyword(s):

Atopic Eczema ◽

Data Extraction ◽

Meta Analysis ◽

Significant Risk ◽

Controlled Trials ◽

Bacterial Strains ◽

Double Blind ◽

Double Blind Placebo ◽

Study Selection ◽

The Impact

In the present study, we sought to conduct a literature review of randomised, double-blind, placebo-controlled trials, which assessed the impact of probiotics intake during pregnancy on the development of eczema in children. A meta-analysis was conducted for comparison of the development of atopic eczema in children whose mothers took probiotics during pregnancyv.placebo. Study selection, quality appraisal and data extraction were performed independently and in duplicate. The studies were rated according to their size in order to calculate the influence of individual studies on the meta-analysis. A total of seven randomised, double-blind, placebo-controlled trials, published between 2001 and 2009, were selected from the PubMed and Ovid databases for the meta-analysis. The meta-analysis was performed with statistical software Stata/SE11.0. The completed meta-analysis of the seven studies shows a significant risk reduction for atopic eczema in children aged 2–7 years by the administration of probiotics during pregnancy (reduction 5·7 %;P = 0·022). However, this effect was only significant for lactobacilli (reduction 10·6 %;P = 0·045), but not for a mixture of various bacterial strains as probiotics (difference 3·06 %,P = 0·204). In conclusion, the meta-analysis shows that the administration of lactobacilli during pregnancy prevents atopic eczema in children aged from 2 to 7 years. However, a mixture of various bacterial strains does not affect the development of atopic eczema, independent of whether they contain lactobacilli or not.

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