Desmopressin for minimising perioperative allogeneic blood transfusion

Desmopressin appears not to reduce need for blood transfusion in patients who do not have congenital bleeding disorders and are undergoing non-urgent or elective surgery.

A Cochrane review included 29 studies with a total of 2 171 subjects. Desmopressin acetate (1-deamino-8-D-arginine-vasopressin, DDAVP) did not significantly reduce the risk of exposure to allogeneic red blood cell (RBC) transfusion (RR 0.96, 95% CI 0.87 to 1.06; 19 studies, n= 1387). However, the use of DDAVP significantly reduced total blood loss (WMD -241.78 ml, 95% CI -387.55 to -96.01 ml; 10 studies, n= 669). Although DDAVP appeared to reduce the overall volume of allogeneic blood transfused during the peri-operative period the result would not be considered clinically significant (WMD -0.3 units, 95% CI -0.60 to -0.01 units; 14 studies, n= 885). Risk of re-operation due to bleeding was not reduced (RR 0.69, 95% CI 0.26 to 1.83; 11 studies, n= 778). DDAVP treatment was not associated with an increased risk of death or myocardial infarction (RR 1.72, 95% CI 0.68 to 4.33, 12 studies, n= 1061; RR 1.38, 95% CI 0.77 to 2.50, 12 studies, n= 876, respectively).

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).

Ədəbiyyat

1. Carless PA, Henry DA, Moxey AJ, O'Connell D, McClelland B, Henderson KM, Sly K, Laupacis A, Fergusson D. Desmopressin for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2004;(1):CD001884 [Last assessed as up-to-date: 20 April 2008].