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. 2004:(1):CD001884.
doi: 10.1002/14651858.CD001884.pub2.

Desmopressin for minimising perioperative allogeneic blood transfusion

P A Carless  1 , D A Henry, A J Moxey, D O'Connell, B McClelland, K M Henderson, K Sly, A Laupacis, D Fergusson
Affiliations

Desmopressin for minimising perioperative allogeneic blood transfusion

P A Carless et al. Cochrane Database Syst Rev. 2004.

Update in

  • Desmopressin use for minimising perioperative blood transfusion.
    Desborough MJ, Oakland K, Brierley C, Bennett S, Doree C, Trivella M, Hopewell S, Stanworth SJ, Estcourt LJ. Desborough MJ, et al. Cochrane Database Syst Rev. 2017 Jul 10;7(7):CD001884. doi: 10.1002/14651858.CD001884.pub3. Cochrane Database Syst Rev. 2017. PMID: 28691229 Free PMC article.

Abstract

Background: Public concerns regarding the safety of transfused blood have prompted re-consideration of the use of allogeneic (from an unrelated donor) red blood cell (RBC) transfusion, and of a range of techniques designed to minimise transfusion requirements.

Objectives: To examine the evidence for the efficacy of desmopressin acetate (1-deamino-8-D-arginine-vasopressin; DDAVP), in reducing perioperative blood loss and the need for red cell transfusion in patients who do not have congenital bleeding disorders.

Search strategy: Articles were identified by: computer searches of MEDLINE, EMBASE, Current Contents (to May 2003), and the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 1, 2003). References in the identified trials and review articles were searched and authors contacted to identify additional studies.

Selection criteria: Controlled parallel group trials in which adult patients, scheduled for non-urgent surgery, were randomised to DDAVP, or to a control group, who did not receive the intervention.

Data collection and analysis: Trial quality was assessed using criteria proposed by Schulz et al. (Schulz 1995) and Jadad et al. (Jadad 1996). Main outcomes measured were: the number of patients exposed to allogeneic red cell transfusion, and the amount of blood transfused. Other outcomes measured were: re-operation for bleeding, blood loss, post-operative complications (thrombosis, infection, non-fatal myocardial infarction), mortality, and length of hospital stay (LOS).

Main results: Eighteen trials of DDAVP (n=1295) reported data on the number of patients transfused with allogeneic RBC transfusion. In subjects treated with DDAVP, the pooled relative risk of exposure to perioperative allogeneic RBC transfusion was 0.95 (95%CI = 0.86 to 1.06). The use of DDAVP did not significantly reduce blood loss; weighted mean difference (WMD) = -114.3ml: 95% confidence interval (95%CI) = -258.8 to 30.2ml per patient) or the volume of RBC transfused (WMD = -0.35 units: 95%CI = -0.70 to 0.01 units). In DDAVP-treated patients the relative risk of requiring re-operation due to bleeding was 0.69 (95%CI = 0.26 to 1.83). There was no statistically significant effect overall for mortality and non-fatal myocardial infarction in DDAVP-treated patients compared with control (RR = 1.72: 95%CI = 0.68 to 4.33) and (RR = 1.38: 95%CI = 0.77 to 2.50) respectively.

Reviewer's conclusions: There is no convincing evidence that desmopressin minimises perioperative allogeneic RBC transfusion in patients who do not have congenital bleeding disorders. These data suggest that there is no benefit from using DDAVP as a means of minimising perioperative allogeneic RBC transfusion.

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Figures

<b>Figure 1</b>
Figure 1. Methodological quality graph: review authors’ judgments about each methodological quality item presented as percentages across all included studies.
<b>Figure 2</b>
Figure 2. Methodological quality summary: review authors’ judgments about each methodological quality item for each included study.
<b>Figure 3</b>
Figure 3. Funnel plot assessment for the presence of publication bias
<b>Figure 4</b>
Figure 4. Funnel plot assessment for the presence of publication bias
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References

References to studies included in this review

    1. Ansell J, Klassen V, Lew R, Ball S, Weinstein M, VanderSalm T, et al. Does desmopressin acetate prophylaxis reduce blood loss after valvular heart operations? A randomized, double-blind study. Journal of Thoracic and Cardiovascular Surgery. 1992;104(1):117–23. - PubMed
    1. Brown MR, Swygert TH, Whitten CW, Hebeler R. Desmopressin acetate following cardiopulmonary bypass: evaluation of coagulation parameters. Journal of Cardiothoracic Anesthesia. 1989;3(6):726–9. - PubMed
    1. Casas JI, Zuazu-Jausoro I, Mateo J, Oliver A, Litvan H, Muniz-Diaz E, Aris A, Caralps JM, Fontcuberta J. Aprotinin versus desmopressin for patients undergoing operations with cardiopulmonary bypass. A double-blind placebo-controlled study. Journal of Thoracic and Cardiovascular Surgery. 1995;110(4 Pt 1):1107–17. - PubMed
    1. Clagett GP, Valentine RJ, Myers SI, Chervu A, Heller J. Does desmopressin improve hemostasis and reduce blood loss from aortic surgery? A randomized, double-blind study. Journal of Vascular Surgery. 1995;22(3):223–30. - PubMed
    1. Despotis GJ, Levine V, Saleem R, Spitznagel E, Joist JH. Use of point-of-care test in identification of patients who can benefit from desmopressin during cardiac surgery: a randomised controlled trial [see comments] Lancet. 1999;354(9173):106–10. - PubMed

Additional references

    1. Bryson GL, Laupacis A, Wells GA. Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion? A meta-analysis. The International Study of Perioperative Transfusion. Anesthesia and Analgesia. 1998;86(1):9–15. - PubMed
    1. Carless PA, Anthony DM, Henry DA. Systematic review of the use of fibrin sealant to minimize perioperative allogeneic blood transfusion. [Review] [41 refs] British Journal of Surgery. 2002;89(6):695–703. - PubMed
    1. Carless PA, Rubens FD, Anthony DM, O’Connell D, Henry DA. Platelet-rich-plasmapheresis for minimising peri-operative allogeneic blood transfusion. Cochrane Database of Systematic Reviews. 2003;(2) DOI: 10.1002/14651858.CD004172. - PubMed
    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 of Systematic Reviews. 2004;(1) DOI: 10.1002/14651858.CD001884.pub2. - PMC - PubMed
    1. Carless PA, Henry DA, Moxey AJ, O’connell DL, Brown T, Fergusson DA. Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews. 2006;(4) DOI: 10.1002/14651858.CD001888.pub2. - PubMed

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