Effects on Coagulation and Fibrinolysis of Desmopressin in Patients Undergoing Total Hip Replacement

Abstract

SummaryTwelve patients undergoing total hip replacement, with regional anaesthesia and with dextran infusion for plasma expansion and thromboprophylaxis, were given the vasopressin analogue desmopressin (DDAVP) or placebo in a randomized, double-blind prospective study. In controls (n = 6) we found a prolongation of the bleeding time, low factor VIII (FVIII) and von Willebrand factor (vWF) and a decrease in antithrombin III to levels known to be at risk for venous thrombosis. Desmopressin shortened postoperative bleeding time, gave an early FVIII/vWF complex increase, prevented antithrombin III from falling to critically low values and appeared to activate the fibrinolytic system, both by tPA increase and PAI-1 decrease.Thus in the controls we found changes in both coagulation and fibrinolysis indicating a haemorrhagic diathesis as well as a risk for thromboembolism. Desmopressin induced factor changes that possibly reduce both risks.

Effects of desmopressin on blood loss in hip arthroplasty

“…Thorbum (1985) did not find any difference in blood loss between two groups of total hip replacement patients receiving ephedrine or no treatment for hypotension. However, a correlation is in accordance with the finding that ephedrine prolongs the bleeding time in healthy volunteers and inhibits platelet aggregation in vitro (Flordal and Svensson 1991).…”

Desmopressin use for minimising perioperative blood transfusion

“…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).…”

“…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).…”

Autologous blood transfusion in hip replacement: No effect on blood loss but less increase of plasminogen activator inhibitor in a randomized series of 80 patients

“…Normally i t rises after trauma, but as has been shown earlier, it is reduced by blood loss and plasma expansion with dextran (Flordal et al 1991). The mean AT-I11 levels were about 70% of the normal value postoperatively in both groups (Bredbacka et al 1987, Flordal et al 199 I).…”