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Vasopressin Therapy of Hemorrhagic Complications Following Coronary Artery Bypass Grafting-Reply

Vasopressin Therapy of Hemorrhagic Complications Following Coronary Artery Bypass Grafting-Reply Abstract In Reply. — Watson raises an interesting and clinically relevant question concerning the use of 1-desamino-8D-arginine vasopressin (DDAVP) in patients with hemorrhagic disorders and coronary artery disease.Intravenous DDAVP administration increases antihemophilic factor (factor VIII) titers in plasma. Given in a standard dose of 0.3 μg/kg, it also provokes a modest rise in factor VII and factor XII concentrations. These properties may, therefore, be considered procoagulant, favoring normal hemostasis.Coronary arterial and other thrombotic events in patients with hemophilia have typically occurred following the intravenous administration of factor VIII concentrate.1,2 Indeed, the case cited3 describes an elderly man with coronary disease risk factors who experienced a myocardial infarction following peripheral vascular surgery. Beyond the fact that coronary disease is highly prevalent in these patients and myocardial infarction is the leading cause of perioperative morbidity and mortality,4 the patient received factor VIII concentrate in addition to DDAVP, the References 1. Ibbotson SH, Grant PJ, Kerry R, Findlay VS, Prentice CRM. The influence of infusions of DDAVP in vivo on the anticoagulant effect of recombinant hirudin in vitro . Thromb Haemost. 1991;65:64-66. 2. Small M, Jack AS, Lowe GDO, et al. Coronary artery disease in severe hemophilia . Br Heart J. 1983;49:604-607.Crossref 3. Bond L, Beven D. Myocardial infarction in a patient with hemophilia treated with DDAVP . N Engl J Med. 1988;318:121. 4. Hertzer NR, Young JR, Kramer JR, et al. Routine coronary angiography prior to elective aortic reconstruction . Arch Surg. 1979;114:1336-1344.Crossref 5. Meade TW, North WRS, Chakrabarti R, et al. Hemostatic function and cardiovascular death: early results of a prospective study . Lancet. 1980;1:1050-1054.Crossref 6. Wilhelmsen L, Svardsudd K, Korsan-Bengsten K, et al. Fibrinogen as a risk factor for stroke and myocardial infarction . N Engl J Med. 1984;311:501-505.Crossref 7. Yarnell JWG, Baker IA, Sweetnam PM, et al. Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease . Circulation. 1991;83:836-844.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Vasopressin Therapy of Hemorrhagic Complications Following Coronary Artery Bypass Grafting-Reply

Vasopressin Therapy of Hemorrhagic Complications Following Coronary Artery Bypass Grafting-Reply

Abstract

Abstract In Reply. — Watson raises an interesting and clinically relevant question concerning the use of 1-desamino-8D-arginine vasopressin (DDAVP) in patients with hemorrhagic disorders and coronary artery disease.Intravenous DDAVP administration increases antihemophilic factor (factor VIII) titers in plasma. Given in a standard dose of 0.3 μg/kg, it also provokes a modest rise in factor VII and factor XII concentrations. These properties may, therefore, be considered procoagulant,...
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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400100150029
Publisher site
See Article on Publisher Site

Abstract

Abstract In Reply. — Watson raises an interesting and clinically relevant question concerning the use of 1-desamino-8D-arginine vasopressin (DDAVP) in patients with hemorrhagic disorders and coronary artery disease.Intravenous DDAVP administration increases antihemophilic factor (factor VIII) titers in plasma. Given in a standard dose of 0.3 μg/kg, it also provokes a modest rise in factor VII and factor XII concentrations. These properties may, therefore, be considered procoagulant, favoring normal hemostasis.Coronary arterial and other thrombotic events in patients with hemophilia have typically occurred following the intravenous administration of factor VIII concentrate.1,2 Indeed, the case cited3 describes an elderly man with coronary disease risk factors who experienced a myocardial infarction following peripheral vascular surgery. Beyond the fact that coronary disease is highly prevalent in these patients and myocardial infarction is the leading cause of perioperative morbidity and mortality,4 the patient received factor VIII concentrate in addition to DDAVP, the References 1. Ibbotson SH, Grant PJ, Kerry R, Findlay VS, Prentice CRM. The influence of infusions of DDAVP in vivo on the anticoagulant effect of recombinant hirudin in vitro . Thromb Haemost. 1991;65:64-66. 2. Small M, Jack AS, Lowe GDO, et al. Coronary artery disease in severe hemophilia . Br Heart J. 1983;49:604-607.Crossref 3. Bond L, Beven D. Myocardial infarction in a patient with hemophilia treated with DDAVP . N Engl J Med. 1988;318:121. 4. Hertzer NR, Young JR, Kramer JR, et al. Routine coronary angiography prior to elective aortic reconstruction . Arch Surg. 1979;114:1336-1344.Crossref 5. Meade TW, North WRS, Chakrabarti R, et al. Hemostatic function and cardiovascular death: early results of a prospective study . Lancet. 1980;1:1050-1054.Crossref 6. Wilhelmsen L, Svardsudd K, Korsan-Bengsten K, et al. Fibrinogen as a risk factor for stroke and myocardial infarction . N Engl J Med. 1984;311:501-505.Crossref 7. Yarnell JWG, Baker IA, Sweetnam PM, et al. Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease . Circulation. 1991;83:836-844.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1991

References