This brief summary is a consequence of the CICM examiner's interest in DDAVP, aprotinin and tranexamic acid. Question 4 from the first paper of 2001 asks the candidate to compare their pharmacodynamic properties. There was nothing particularly "cardiothoracic" about the discussion of the college answer in this question, and it has been relegated into the haematology section.
As with many such questions, the answer looks better when tabulated.
Properties | DDAVP | Aprotinin | Tranexamic acid |
Class |
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Mechanism |
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Dose |
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30 mg/kg bolus followed by 16 mg/kg/hr infusion seems to be the favoured dose. |
Advantages |
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Disadvantages |
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Side effects |
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A comparative review of all three substances is available; in summary its findings are as follows:
Sigaut, Stéphanie, et al. "Comparison of two doses of tranexamic acid in adults undergoing cardiac surgery with cardiopulmonary bypass." Anesthesiology120.3 (2014): 590-600.
Laupacis, Andreas, and Dean Fergusson. "Drugs to minimize perioperative blood loss in cardiac surgery: meta-analyses using perioperative blood transfusion as the outcome." Anesthesia & Analgesia 85.6 (1997): 1258-1267.
Levi, Marcel, et al. "Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints." The Lancet 354.9194 (1999): 1940-1947.