Desmopressin and bleeding time in patients with cirrhosis.

Burroughs, A K; Matthews, Ken; Qadiri, M; Thomas, Niclas; Kernoff, P. B. A.; Tuddenham, Edward G. D.; McIntyre, N

doi:10.1136/bmj.291.6506.1377

Cited by 107 publications

(49 citation statements)

References 25 publications

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“…This effect is thought to be due to an increase in plasma levels of large molecular weight multimers of the von Willebrand factor molecule, which facilitates platelet adhesion to the subendothelium [18]. Controversial data have been reported about the effects of desmo pressin on PT and on the plasma level of other coagulation factors [8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Desmopressin (dDAVP) has been shown to improve primary hemostasis in patients with a variety of conditions [7], Previous controlled studies [9,10,17] have shown that dDAVP infusion in liver cirrhosis patients, both by intravenous and subcutaneous route, induces a significant shortening in bleeding time along with the expected increase in plasma factor VIII coagulant activity and von Willebrand factor. This effect is thought to be due to an increase in plasma levels of large molecular weight multimers of the von Willebrand factor molecule, which facilitates platelet adhesion to the subendothelium [18].…”

Section: Discussionmentioning

confidence: 99%

“…An intravenous infusion of dDAVP also shortens the prolonged bleeding times of patients with a variety of bleeding disorders, including ure mia and liver cirrhosis [7], We have previously observed in an uncon trolled study [8] that the infusion of 0.5 pg/kg of dDAVP in 8 patients with liver cirrhosis, in addition to the well-known effect on activated partial thromboplastin time (APTT) and fac tor VIII, is able to shorten prolonged pro thrombin time (PT) and to increase plasma levels of coagulation factors VII, IX, XI and XII. Subsequently, two controlled studies ex plored the effects of dDAVP on hemostasis in patients with liver disease [9,10], Both stud ies showed a significant shortening of the bleeding time and APTT and an increase on factor VIII complex whereas no changes of prothrombin times were observed. Burroughs et al reported both an increase [11] and no change [9] in plasma levels of factor XI and XII after dDAVP infusion.…”

Section: Introductionmentioning

confidence: 99%

“…Subsequently, two controlled studies ex plored the effects of dDAVP on hemostasis in patients with liver disease [9,10], Both stud ies showed a significant shortening of the bleeding time and APTT and an increase on factor VIII complex whereas no changes of prothrombin times were observed. Burroughs et al reported both an increase [11] and no change [9] in plasma levels of factor XI and XII after dDAVP infusion. These conflicting results prompted us to perform a double blind, cross-over, randomized study aimed at comparing the effects on hemostasis of dDAVP and placebo in patients with liver cir rhosis.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Desmopressin on Hemostasis in Patients with Liver Cirrhosis

Agnelli

Parise²,

Levi³

et al. 1995

Pathophysiol Haemos Thromb

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The aim of this double-blind, placebo-controlled crossover study was to investigate the effect of 1-deamino-8-D-arginine vasopressin (dDAVP) on hemostasis in patients with chronic liver disease. Nine consecutive patients with biopsy-proven liver cirrhosis and related coagulation abnormalities received in a random order dDAVP, 0.5 μg/kg, or saline intravenously. Blood samples were taken before dDAVP infusion and 30, 60 and 180 min after its end. dDAVP infusion induced a statistically significant shortening of the bleeding time from 9 min (range 6.5-15.5) to 6 min (range 4.5-9.5) at 1 h after the infusion. The activated partial thromboplastin time was significantly shortened at 30 and 60 min after dDAVP infusion. Plasma levels of factor VIII, XI and XII coagulant activities were significantly increased at all sampling times after dDAVP infusion. The maximum increase over basal values in plasma levels of factor VIII, XI and XII was 63, 22 and 40%, respectively. dDAVP did not induce any significant changes of prothrombin time, thrombin clotting time, fibrinogen, plasma levels of factor II, V, VII, IX, X, factor XII antigen, protein C (activity and antigen), antithrombin III, plasminogen and α₂-antiplasmin. Placebo infusion did not produce any significant changes in the evaluated parameters. We conclude that dDAVP can positively influence the hemostatic system in patients with liver cirrhosis. The clinical relevance of this hemostatic improvement deserves further evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Desmopressin on Hemostasis in Patients with Liver Cirrhosis

Agnelli

Parise²,

Levi³

et al. 1995

Pathophysiol Haemos Thromb

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“…In patients with liver failure, its administration at a dose of 0.3 mg/kg shortened the bleeding time [154]. However, the clinical benefit of this effect remains to be verified.…”

Section: Desmopressinmentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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