Desmopressin in Cardiac Surgery with Extra-Corporeal Circulation

Rocha, Eduardo; Páramo, José A.; Llorens, R.; Hidalgo, F.

doi:10.1007/978-1-4615-2922-4_21

Cited by 2 publications

(10 citation statements)

References 36 publications

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“…We obtained the full text of the remaining 117 records and excluded 33 of them. We divided multi-arm trials into separate trials, which yielded 70 studies with 84 records: 65 completed trials (Aida 1991a; Aida 1991b; Alanay 1999; Andersson 1990; Ansell 1992; Bignami 2016; Brown 1989; Casas 1995; Chuang 1993; Clagett 1995; de Prost 1992; Despotis 1999; Dilthey 1993; Ellis 2001; Flordal 1991; Flordal 1992; Frankville 1991; Gratz 1992; Guay 1992; Guyuron 1996; Hackmann 1989; Hajjar 2007; Hedderich 1990; Hemş inli 2012a; Hemş inli 2012b; Hemş inli 2012c; Horrow 1991a; Horrow 1991b; Horrow 1991c; Jin 2015; Karnezis 1994a; Karnezis 1994b; Kobrinsky 1987; Kuitunen 1992; Lazarchick 1995; Lee 2010; Leino 2010; Lethagen 1991; Letts 1998; Manno 2011; Marczinski 2007; Marquez 1992; Mongan 1992a; Mongan 1992b; Oliver 2000; Ozkisacik 2001; Pleym 2004; Reich 1991; Reynolds 1993; Rocha 1988; Rocha 1994; Salmenpera 1991; Salzman 1986; Schott 1995; Seear 1989; Shao 2015; Sheridan 1994; Spyt 1990; Steinlechner 2011; Temeck 1994; Theroux 1997; Wingate 1992a; Wingate 1992b; Wong 2003; Zohar 2001); four ongoing trials (ISRCTN12845429; NCT00885924; NCT01982760; NCT02084342); and one trial awaiting classification (Jahangirifard 2017).…”

Section: Resultsmentioning

confidence: 99%

“…We considered 35 trials to be at low risk of bias for incomplete outcome data because participants were analysed on an ITT basis (Aida 1991a; Aida 1991b; Alanay 1999; Ansell 1992; Bignami 2016; Brown 1989; Clagett 1995; Despotis 1999; Ellis 2001; Flordal 1991; Flordal 1992; Frankville 1991; Gratz 1992; Guay 1992; Guyuron 1996; Jin 2015; Kobrinsky 1987; Lee 2010; Manno 2011; Marczinski 2007; Mongan 1992a; Mongan 1992b; Oliver 2000; Ozkisacik 2001; Reich 1991; Rocha 1988; Salmenpera 1991; Salzman 1986; Schott 1995; Seear 1989; Shao 2015; Sheridan 1994; Theroux 1997; Wingate 1992a; Wingate 1992b).…”

Section: Resultsmentioning

confidence: 99%

“…Restricting the analysis to trials published as full-text papers resulted in reduced effect estimate and heterogeneity (MD -0.30 units; 95 % CI -0.63 to 0.04 units; I 2 = 49%; 12 trials, 759 participants; analysis not shown) (Ansell 1992; Brown 1989; de Prost 1992; Despotis 1999; Dilthey 1993; Gratz 1992; Hedderich 1990; Ozkisacik 2001; Reich 1991; Rocha 1988; Salzman 1986; Steinlechner 2011).…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen trials (933 participants) reported intraoperative blood loss (Brown 1989; Flordal 1992; Guay 1992; Hackmann 1989; Kobrinsky 1987; Leino 2010; Lethagen 1991; Letts 1998; Marczinski 2007; Oliver 2000; Rocha 1988; Salzman 1986; Schott 1995; Shao 2015; Wingate 1992a; Wingate 1992b; Wong 2003). Clinical heterogeneity due to differences in baseline blood loss meant that it was not possible to calculate a pooled estimate for the whole population, and we performed analyses in subgroups according to type of surgery (Analysis 1.6).…”

Section: Resultsmentioning

confidence: 99%

“…Four trials (337 participants) reported intraoperative blood loss for adult cardiac surgery (Brown 1989; Hackmann 1989; Rocha 1988; Salzman 1986), but two trials (250 participants) did not report this outcome in a way that allowed inclusion in meta-analysis, and so we reported this information narratively in Table 5. We found no evidence of a difference in intraoperative blood loss for participants treated with DDAVP versus placebo (MD -138.2 mL, 95% CI -623.4 mL to 347.01 mL; I 2 = 85%; 2 trials, 87 participants; Analysis 1.6).…”

Section: Resultsmentioning

confidence: 99%

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Desmopressin use for minimising perioperative blood transfusion

Desborough

Oakland

Brierley

et al. 2017

Cochrane Database of Systematic Reviews

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Background Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. Objectives To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (2017, issue 3) in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the Transfusion Evidence Library (from 1980), and ongoing trial databases (all searches to 3 April 2017). Selection criteria We included randomised controlled trials comparing DDAVP to placebo or an active comparator (e.g. tranexamic acid, aprotinin) before, during, or immediately after surgery or after invasive procedures in adults or children. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We identified 65 completed trials (3874 participants) and four ongoing trials. Of the 65 completed trials, 39 focused on adult cardiac surgery, three on paediatric cardiac surgery, 12 on orthopaedic surgery, two on plastic surgery, and two on vascular surgery; seven studies were conducted in surgery for other conditions. These trials were conducted between 1986 and 2016, and 11 were funded by pharmaceutical companies or by a party with a commercial interest in the outcome of the trial. The GRADE quality of evidence was very low to moderate across all outcomes. No trial reported quality of life. DDAVP versus placebo or no treatment Trial results showed considerable heterogeneity between surgical settings for total volume of red cells transfused (low-quality evidence) and for total blood loss (very low-quality evidence) due to large differences in baseline blood loss. Consequently, these outcomes were not pooled and were reported in subgroups. Compared with placebo, DDAVP may slightly decrease the total volume of red cells transfused in adult cardiac surgery (mean difference (MD) -0.52 units, 95% confidence interval (CI) -0.96 to -0.08 units; 14 trials, 957 participants), but may lead to little or no difference in orthopaedic surgery (MD -0.02, 95% CI -0.67 to 0.64 units; 6 trials, 303 participants), vascular surgery (MD 0.06, 95% CI -0.60 to 0.73 units; 2 trials, 135 participants), or hepatic surgery (MD -0.47, 95% CI -1.27 to 0.33 units; 1 trial, 59 participants). DDAVP probably leads to little or no difference in the total number of participants transfused with blood (risk ratio (RR) 0.96, 95% CI 0.86 to 1.06; 25 trials; 1806 participants) (moderate-quality evidence). Whether DDAVP decreases total blood loss in adult cardiac surgery (MD -135.24 mL, 95% CI -210.80 mL to -59.68 mL; 22 trials, 1358 pa...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Desmopressin use for minimising perioperative blood transfusion

Desborough

Oakland

Brierley

et al. 2017

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

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Randomized study of aprotinin and DDAVP to reduce postoperative bleeding after cardiopulmonary bypass surgery.

et al. 1994

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Background Patients on cardiopulmonary bypass (CPB) have an increased susceptibility to postoperative bleeding. Previous reports using desmopressin acetate (DDAVP) for the prevention of postoperative bleeding have given contradictory results, whereas the protease inhibitor aprotinin has been shown to reduce blood loss after this type of surgery. This randomized study was performed to assess the efficacy of DDAVP versus aprotinin in the prevention of bleeding after CPB.Methods and Results One hundred nine of 122 eligible patients were randomized to four different groups: Group A (n=28) received aprotinin starting with a bolus of 2x 106 KIU followed by a continuous infusion of 0.5 x 106 KIU/h until the

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Desmopressin in Cardiac Surgery with Extra-Corporeal Circulation

Cited by 2 publications

References 36 publications

Desmopressin use for minimising perioperative blood transfusion

Desmopressin use for minimising perioperative blood transfusion

Randomized study of aprotinin and DDAVP to reduce postoperative bleeding after cardiopulmonary bypass surgery.

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