Ddavp Reduces Blood Loss and Transfusion in Cardiac Surgical Patients With Impaired Platelet Function Identified Using a Point-of-Care Test

Despotis, George J.; Levine, Vladimir; Saleem, Rao; Joist, J. Heinrich; Spitznagel, Edward L.

doi:10.1097/00000542-199809060-00001

Cited by 6 publications

(23 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…Twenty-one trials were at low risk of bias for sequence generation because they used either: a table of random numbers (Horrow 1991a; Horrow 1991b; Horrow 1991c; Karnezis 1994a; Karnezis 1994b; Leino 2010; Manno 2011; Oliver 2000; Wingate 1992a; Wingate 1992b); orcomputer-generated random numbers (Ansell 1992; Bignami 2016; Despotis 1999; Ellis 2001; Hedderich 1990; Mongan 1992a; Mongan 1992b; Pleym 2004; Shao 2015; Steinlechner 2011; Zohar 2001). …”

Section: Resultsmentioning

confidence: 99%

“…computer-generated random numbers (Ansell 1992; Bignami 2016; Despotis 1999; Ellis 2001; Hedderich 1990; Mongan 1992a; Mongan 1992b; Pleym 2004; Shao 2015; Steinlechner 2011; Zohar 2001).…”

Section: Resultsmentioning

confidence: 99%

See 2 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

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...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

show abstract

“…In situations in which the trial test cannot be done in the child, information can be obtained by testing the affected parent. The question remains open whether the BT as an in vivo test ( Sutor, 1998b) or in vitro platelet function tests, such as the platelet function analyser ( Goudemand et al , 1999 ), platelet aggregation at high shear rate ( Cattaneo et al , 1995a ), haemoSTATUS ( Despotis et al , 1999 ) or Real Time ( Keularts et al , 1999 ), mirror the clinical situation better. It is important to remember that in vitro tests do not give information on the vascular haemostatic system.…”

Section: Practical Approach To Ddavp Testing and Treatmentmentioning

confidence: 99%

Ddavp Is Not a Panacea for Children With Bleeding Disorders

Sutor

2000

Br J Haematol

View full text Add to dashboard Cite

“…Desmopressin-treated patients had a 50% reduction in red cell (1.1 vs 2.2 U), 95% reduction in platelet (0.1 vs 1.9 U) and 87% reduction in fresh frozen plasma (0.1 vs 0.8 U) units transfused with an overall 69% reduction in total donor exposures (1.6 vs 5.2 U) when compared to placebo patients. When compared to placebotreated patients, patients who received desmopressin also had a 39% (182 vs 297 ml), 42% (299 vs 513 ml) and 39% (624 vs 1028 ml) reduction in blood loss in the first 4, 8 and 24 postoperative hours, respectively (73). In conclusion, use of point-of-care (POC) tests of hemostatic function can facilitate the optimal management of excessive bleeding and reduce transfusion.…”

Section: G Despotismentioning

confidence: 96%