Abstract
Purpose
To determine the effects of desmopressin on coagulation and blood loss in patients undergoing elective partial hepatectomy.
Methods
A randomized, controlled and double-blind study on 59 patients who received either 0.3 μg·kg−1 of desmopressin or an equal volume of normal saline (control) infused intravenously over 20 min after induction of general anesthesia.
Results
There was an increase in plasma levels of factors VIII and von Willebrand after the infusion of study drug in both groups (P < 0.001). The activated partial thromboplastin time was shortened in Group D whereas prothrombin time was prolonged in Group C; (P = 0.02). A large range of intraoperative blood loss (400–7128 mL) was observed, with no significant differences between groups. There were no changes in plasma electrolyte levels or osmolality. Transfusion requirements were similar in both groups.
Conclusion
Desmopressin did not reduce intraoperative blood loss or transfusion requirements during hepatectomy despite raising clotting factor levels and improving tests of hemostasis.
Résumé
Objectif
Déterminer les effets de la desmopressine sur la coagulation et les pertes sanguines pendant une hépatectomie partielle réglée.
Méthode
Il s’agit d’une étude randomisée, contrôlée et à double insu auprès de 59 patients qui ont reçu, soit 0,3 μg·kg−1 de desmopressine ou un volume égale de soluté normal (témoin) administré par voie intraveineuse 20 min au moins après l’induction de l’anesthésie générale.
Résultats
On a noté une augmentation des niveaux plasmatiques des facteurs VIII et von Willebrand à la suite de la perfusion du médicament expérimenté chez les patients des deux groupes (P < 0,001). Le temps de céphaline activé a été plus court dans le groupe D tandis que le temps de prothrombine a été plus long dans le groupe T ; (P = t0,02). D’importants écarts ont été observés pour les pertes sanguines peropératoires (400–7128 mL), mais sans différence significative intergroupe. Aucune modification des niveaux plasmatiques d’électrolyte ou d’osmolalité n’a été notée. Les besoins de transfusion ont été comparables dans les deux groupes.
Conclusion
La desmopressine ne réduit pas les pertes sanguines ou les besoins de transfusion peropératoires pendant l’hépatectomie, malgré l’élévation des niveaux de facteurs de coagulation et l’amélioration de l’hémostase.
Article PDF
Similar content being viewed by others
References
Lethagen S. Desmopressin—a haemostatic drug: state-of-the-art review. Eur J Anaesthesiol 1997; 14(Suppl 14): 1–9.
Theroux MC, Corddry DH, Tietz AE, Miller F, Peoples JD, Kettrick RG. A study of desmopressin and blood loss during spinal fusion for neuromuscular scoliosis. A randomized, controlled, double-blinded study. Anesthesiology 1997; 87: 260–7.
Alanay A, Acaroglu E, Ozdemir O, Ercelen O, Bulutcu E, Surat A. Effects of deamino-8-D-arginin vasopressin on blood loss and coagulation factors in scoliosis surgery: a double-blind randomized clinical trial. Spine 1999; 24: 877–82.
Karnezis TA, Stulberg SD, Wixson RL, Reilly P. The hemostatic effects of desmopressin on patients who had total joint arthroplasty. A double-blind randomized trial. J Bone Joint Surg 1994; 76: 1545–50.
Clagett GP, Valentine RJ, Myers SI, Chervu A, Heller J. Does desmopressin improve hemostasis and reduce blood loss from aortic surgery? A randomized, double-blind study. J Vasc Surg 1995; 22: 223–9.
Guyuron B, Vaughan C, Schlecter B. The role of DDAVP (desmopressin) in orthognathic surgery. Ann Plast Surg 1996; 37: 516–9.
Johnson RG, Murphy JM. The role of desmopressin in reducing blood loss during lumbar fusions. Surg Gynecol Obstet 1990; 171: 223–6.
Henry DA, Moxey AJ, Carless PA, et al. The Cochrane database of systematic reviews. Desmopressin for minimising perioperative allogeneic blood transfusion. The Cochrane Library 2002; (Issue 1): 1–27.
Jamieson GG, Corbel L, Campion JP, Launois B. Major liver resection without a blood transfusion: is it a realistic objective? Surgery 1992; 112: 32–6.
Burroughs AK, Matthews K, Qadiri M, et al. Desmopressin and bleeding time in patients with cirrhosis. Br Med J 1985; 291: 1377–81.
Agnelli G, Parise P, Levi M, Cosmi B, Nenci GG. Effects of desmopressin on hemostasis in patients with liver cirrhosis. Haemostasis 1995; 25: 241–7.
Erstad BL. Systemic hemostatic medications for reducing surgical blood loss. Ann Pharmacother 2001; 35: 925–34.
Lentschener C, Benhamou D, Mercier FJ, et al. Aprotinin reduces blood loss in patients undergoing elective liver resection. Anesth Analg 1997; 84: 875–81.
Hunt BJ. Desmopressin and bleeding during invasive surgery. Eur J Anaesthesiol 1997; 14(Suppl 14): 42–9.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was supported by a Hong Kong University CRCG grant (10202115/20013/20100/323/01). We declare no conflict of interest in this study.
Rights and permissions
About this article
Cite this article
Wong, A.Y.C., Irwin, M.G., Hui, T.W.C. et al. Desmopressin does not decrease blood loss and transfusion requirements in patients undergoing hepatectomy. Can J Anesth 50, 14–20 (2003). https://doi.org/10.1007/BF03020180
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03020180