Desmopressin-induced release of tissue plasminogen activator from endothelial cells explain the absence of its hemostatic effect in patients undergoing cardiac surgery. Prior administration of the antifibrinolytic agent tranexamic acid might unmask such an effect, and combination therapy might therapy improve the postoperative hemostasis.

Patients who undergone elective coronary artery bypass surgery between january 1997-january 1998, were divided into the three groups. Each groups included 20 patients. Placebo in Group I, Desmopressin (0.3 mg /kg) in group II, desmopressin (0.3 mg/kg)+tranexamic acid (10 mg/kg) in group III, just after protamine infusions were administrated. Patients were followed by aPTT, Platelet count, fibrinogen, FDP values, blood loss and transfusion requirement on the early postoperative period.

FDP was highest value (21±2 mgr/ml) in group II, Group I and Group III had lower FDP values (8±2, 15±2 mgr/ml). Blood loss was 1075±65 ml/day in Group II, 950±45 in Group 1,725±25 in Group III (p<0.05). Transfusion requirement in group I was 68%, 72% in Group II, 48% in Group III. Statistically significant differance was found between Group II and Group III (p< 0.05).

Desmopressin exerts hemostatic effect with prior administration tranexamic acid which is neutralized desmopressin-induced release of tissue plasminogen activators. Desmopressin (0.3 mg/kg)+Tranexamic acid (10 mg/kg) reduces postoperative blood loss and transfusion requirement more than placebo.

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