deamino-arginine-vasopressin and Coronary-Disease

Topics: Adrenocorticotropic Hormone; Anabolic Agents; Androgens; Clofibrate; Coronary Disease; Deamino Arginine Vasopressin; Drug Therapy, Combination; Female; Fibrinolysis; Fibrinolytic Agents; Glucocorticoids; Humans; Inflammation; Male; Metformin; Phenformin; Plasminogen Activators; Postoperative Complications; Sulfonylurea Compounds; Thromboembolism; Thrombophlebitis; Vascular Diseases

Previous studies have suggested that the administration of desmopressin (DDAVP) may reduce blood loss after cardiac surgery. The present double-blind, randomized, placebo-controlled trial was performed to determine the effect of DDAVP on haemostasis during and after primary coronary artery bypass surgery. Fifteen patients received an infusion of DDAVP 0.3 microgram/kg and 15 patients received a placebo infusion over 15 min after cardiopulmonary bypass. Following DDAVP administration, the increase in factor VIII:C plasma level was greater than after placebo (the increase at 90 min after treatment 1.10 +/- 0.11 vs. 0.45 +/- 0.09 IU/ml, P less than 0.01). A difference between the treatments tended to occur also in the increase of von Willebrand antigen (0.64 +/- 0.08 vs. 0.23 +/- 0.07 IU/ml, P = 0.0556). A detailed evaluation of various haemostatic parameters showed no significant changes towards hypercoagulability or fibrinolysis. Inspite of the observed potential haemostatic effect of DDAVP, patients treated with DDAVP and placebo had similar postoperative blood losses (950 +/- 185 vs. 1034 +/- 321 ml), similar total haemoglobin losses (45.9 +/- 11.1 vs. 54.7 +/- 25.9 g) and similar red cell transfusion requirements (1.3 (range 0-2) vs. 1.1 (range 0-3) units). The plasma concentrations of factor F VIII:C and von Willebrand factor antigen after cardiopulmonary bypass may explain the failure to achieve a therapeutic effect with DDAVP.

Topics: Blood Coagulation Tests; Blood Loss, Surgical; Coronary Artery Bypass; Coronary Disease; Deamino Arginine Vasopressin; Factor VIII; Female; Hemostasis, Surgical; Humans; Male; Middle Aged

We present a case of nephrogenic diabetes insipidus that occurred after on-pump coronary artery bypass grafting in a patient taking long-term lithium carbonate. Lithium toxicity (2.79 mmol/L) was identified on postoperative day 9. Serum sodium peaked at 175 mmol/L on postoperative day 21. Serum osmolality peaked at 384 mOsm/kg H2O, with a urinary osmolality of 403 mOsm/kg H2O. The patient was ultimately managed with hemofiltration and high-dose 1-desamino-8-D-arginine-vasopressin. Recommendations are made based on our experience of this case. In patients on long-term lithium therapy, the potentially life-threatening complication of lithium-induced nephrogenic diabetes insipidus should be specifically anticipated and managed.

Topics: Bipolar Disorder; Coronary Artery Bypass; Coronary Disease; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemofiltration; Humans; Lithium Carbonate; Male; Middle Aged; Postoperative Complications; Treatment Outcome

Topics: 3' Untranslated Regions; Activated Protein C Resistance; Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Contraindications; Coronary Disease; Deamino Arginine Vasopressin; Factor V; Factor VIII; Female; Genetic Predisposition to Disease; Genotype; Heparin; Humans; Hypertension; Postoperative Complications; Prothrombin; Pulmonary Embolism; Thrombophilia; von Willebrand Diseases; von Willebrand Factor

A 20-min venous occlusion and a desmopressin acetate (DDAVP, 0.4 microgram.Kg-1, 15 min) infusion test have been compared to evaluate fibrinolytic capacity in proven coronary artery disease. Basal values of plasma tissue plasminogen activator (t-PA) activity and antigen and of t-PA inhibitor (PAI) were normally distributed in this patient group. However, after both stimuli, highly significant (P less than 0.005) increases of t-PA antigen and activity have been observed. Renormalization of t-PA levels after DDAVP infusion occurred more rapidly for antigen (120 min) than for activity concentrations (greater than 240 min). A DDAVP infusion test seems more appropriate for evaluation of the fibrinolytic capacity as the induced decrease in PAI level was significant (P less than 0.005) and lasted for at least 240 min, while it was not significant for the venous occlusion test.

Topics: Arm; Coronary Disease; Deamino Arginine Vasopressin; Humans; Infusions, Parenteral; Middle Aged; Tissue Plasminogen Activator; Tourniquets

Topics: Coronary Disease; Coronary Thrombosis; Deamino Arginine Vasopressin; Humans; Myocardial Infarction

Twenty healthy individuals (15 men and 5 women) with initial fasting serum triglycerides greater than or equal to 1.80 mmol/l and euglobulin clot lysis time after venous occlusion greater than or equal to 60 min (upper normal limit 45 min) were tested for fibrinolytic response to venous occlusion and intravenous injection of desmopressin (DDAVP), serum lipids, serum glucose and relative body weight before and after a minimum of 3 to a maximum of 12 months' diet intervention. In order to be defined as a good diet responder, at least 20% reduction of the initial serum triglyceride concentration was required. At the end of the study, half of the participants (7 men and 3 women) met the criteria of good diet responders. All of these showed an improved fibrinolytic response to DDAVP injection, and 7 out of 10 had a normalized fibrinolytic response to venous occlusion. We conclude that, through dietary measures with substantial reduction of hypertriglyceridaemia, it is possible to improve and even normalize the fibrinolytic potential.

Topics: Adult; Blood Glucose; Body Weight; Coronary Disease; Deamino Arginine Vasopressin; Diet; Female; Fibrinolysis; Humans; Male; Prospective Studies; Risk Factors; Triglycerides