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Meta-Analysis
. 2017 Jul 10;7(7):CD001884.
doi: 10.1002/14651858.CD001884.pub3.

Desmopressin use for minimising perioperative blood transfusion

Michael J Desborough  1 , Kathryn Oakland, Charlotte Brierley, Sean Bennett, Carolyn Doree, Marialena Trivella, Sally Hopewell, Simon J Stanworth, Lise J Estcourt
Affiliations
Meta-Analysis

Desmopressin use for minimising perioperative blood transfusion

Michael J Desborough et al. Cochrane Database Syst Rev. .

Abstract

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 treatmentTrial 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 participants), orthopaedic surgery (MD -285.76 mL, 95% CI -514.99 mL to -56.53 mL; 5 trials, 241 participants), or vascular surgery (MD -582.00 mL, 95% CI -1264.07 mL to 100.07 mL; 1 trial, 44 participants) is uncertain because the quality of evidence is very low.DDAVP probably leads to little or no difference in all-cause mortality (Peto odds ratio (pOR) 1.09, 95% CI 0.51 to 2.34; 22 trials, 1631 participants) or in thrombotic events (pOR 1.36, 95% CI, 0.85 to 2.16; 29 trials, 1984 participants) (both low-quality evidence). DDAVP versus placebo or no treatment for people with platelet dysfunctionCompared with placebo, DDAVP may lead to a reduction in the total volume of red cells transfused (MD -0.65 units, 95% CI -1.16 to -0.13 units; 6 trials, 388 participants) (low-quality evidence) and in total blood loss (MD -253.93 mL, 95% CI -408.01 mL to -99.85 mL; 7 trials, 422 participants) (low-quality evidence).DDAVP probably leads to little or no difference in the total number of participants receiving a red cell transfusion (RR 0.83, 95% CI 0.66 to 1.04; 5 trials, 258 participants) (moderate-quality evidence).Whether DDAVP leads to a difference in all-cause mortality (pOR 0.72, 95% CI 0.12 to 4.22; 7 trials; 422 participants) or in thrombotic events (pOR 1.58, 95% CI 0.60 to 4.17; 7 trials, 422 participants) is uncertain because the quality of evidence is very low. DDAVP versus tranexamic acidCompared with tranexamic acid, DDAVP may increase the volume of blood transfused (MD 0.6 units, 95% CI 0.09 to 1.11 units; 1 trial, 40 participants) and total blood loss (MD 142.81 mL, 95% CI 79.78 mL to 205.84 mL; 2 trials, 115 participants) (both low-quality evidence).Whether DDAVP increases or decreases the total number of participants transfused with blood is uncertain because the quality of evidence is very low (RR 2.42, 95% CI 1.04 to 5.64; 3 trials, 135 participants).No trial reported all-cause mortality.Whether DDAVP leads to a difference in thrombotic events is uncertain because the quality of evidence is very low (pOR 2.92, 95% CI 0.32 to 26.83; 2 trials, 115 participants). DDAVP versus aprotininCompared with aprotinin, DDAVP probably increases the total number of participants transfused with blood (RR 2.41, 95% CI 1.45 to 4.02; 1 trial, 99 participants) (moderate-quality evidence).No trials reported volume of blood transfused or total blood loss and the single trial that included mortality as an outcome reported no deaths.Whether DDAVP leads to a difference in thrombotic events is uncertain because the quality of evidence is very low (pOR 0.98, 95% CI 0.06 to 15.89; 2 trials, 152 participants).

Authors' conclusions: Most of the evidence derived by comparing DDAVP versus placebo was obtained in cardiac surgery, where DDAVP was administered after cardiopulmonary bypass. In adults undergoing cardiac surgery, the reduction in volume of red cells transfused and total blood loss was small and was unlikely to be clinically important. It is less clear whether DDAVP may be of benefit for children and for those undergoing non-cardiac surgery. A key area for researchers is examining the effects of DDAVP for people with platelet dysfunction. Few trials have compared DDAVP versus tranexamic acid or aprotinin; consequently, we are uncertain of the relative efficacy of these interventions.

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Conflict of interest statement

  1. Michael Desborough: investigator for a trial of DDAVP for treatment of thrombocytopenia

  2. Kathryn Oakland: none known

  3. Charlotte Brierley: none known

  4. Sean Bennett: none known

  5. Carolyn Doree: none known

  6. Marialena Trivella: none known

  7. Sally Hopewell: none known

  8. Simon J Stanworth: investigator for a trial of DDAVP for treatment of thrombocytopenia

  9. Lise J Estcourt: none known

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Funnel plot of comparison: desmopressin vs placebo: total red cell volume transfused. CI: confidence interval; MD: mean difference; SE: standard error.
4
4
Funnel plot of comparison: desmopressin vs placebo: number of participants receiving a red cell transfusion. CI: confidence interval; RR: relative risk.
5
5
Funnel plot of comparison: desmopressin vs placebo: total blood loss. CI: confidence interval; MD: mean difference; SE: standard error.
1.1
1.1. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 1 Red cell volume transfused (intraoperatively).
1.2
1.2. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 2 Red cell volume transfused (total).
1.3
1.3. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 3 Red cell volume transfused (children only, total).
1.4
1.4. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 4 Number of participants receiving a red cell transfusion (intraoperatively).
1.5
1.5. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 5 Number of participants receiving a red cell transfusion (total).
1.6
1.6. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 6 Blood loss (intraoperative).
1.7
1.7. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 7 Blood loss (total).
1.8
1.8. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 8 Blood loss (children only, total).
1.9
1.9. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 9 Number of participants with any bleeding (intraoperatively).
1.10
1.10. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 10 Number of participants with any bleeding (total).
1.11
1.11. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 11 Reoperation due to bleeding.
1.12
1.12. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 12 All‐cause mortality.
1.13
1.13. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 13 All thrombotic events (including myocardial infarction, ischaemic stroke, other arterial thromboembolism, and venous thromboembolism).
1.14
1.14. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 14 Myocardial infarction.
1.15
1.15. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 15 Stroke.
1.16
1.16. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 16 Venous thromboembolism.
1.17
1.17. Analysis
Comparison 1 Desmopressin vs placebo, Outcome 17 Clinically important hypotension.
2.1
2.1. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 1 Red cell volume transfused (total).
2.2
2.2. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 2 Number of participants receiving a red cell transfusion (intraoperatively).
2.3
2.3. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 3 Number of participants receiving a red cell transfusion (total).
2.4
2.4. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 4 Blood loss (total).
2.5
2.5. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 5 Reoperation due to bleeding.
2.6
2.6. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 6 All‐cause mortality.
2.7
2.7. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 7 All thrombotic events (including myocardial infarction, ischaemic stroke, other arterial thromboembolism, and venous thromboembolism).
2.8
2.8. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 8 Myocardial infarction.
2.9
2.9. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 9 Stroke.
2.10
2.10. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 10 Venous thromboembolism.
2.11
2.11. Analysis
Comparison 2 Desmopressin vs placebo (platelet dysfunction), Outcome 11 Clinically important hypotension.
3.1
3.1. Analysis
Comparison 3 Desmopressin vs tranexamic acid, Outcome 1 Red cell volume transfused (total).
3.2
3.2. Analysis
Comparison 3 Desmopressin vs tranexamic acid, Outcome 2 Number of participants receiving a red cell transfusion (total).
3.3
3.3. Analysis
Comparison 3 Desmopressin vs tranexamic acid, Outcome 3 Blood loss (total).
3.4
3.4. Analysis
Comparison 3 Desmopressin vs tranexamic acid, Outcome 4 Reoperation due to bleeding.
3.5
3.5. Analysis
Comparison 3 Desmopressin vs tranexamic acid, Outcome 5 All thrombotic events (including myocardial infarction, ischaemic stroke, other arterial thromboembolism, and venous thromboembolism).
3.6
3.6. Analysis
Comparison 3 Desmopressin vs tranexamic acid, Outcome 6 Myocardial infarction.
3.7
3.7. Analysis
Comparison 3 Desmopressin vs tranexamic acid, Outcome 7 Stroke.
3.8
3.8. Analysis
Comparison 3 Desmopressin vs tranexamic acid, Outcome 8 Venous thromboembolism.
4.1
4.1. Analysis
Comparison 4 Desmopressin vs aprotinin, Outcome 1 Number of participants receiving a red cell transfusion (total).
4.2
4.2. Analysis
Comparison 4 Desmopressin vs aprotinin, Outcome 2 Reoperation due to bleeding.
4.3
4.3. Analysis
Comparison 4 Desmopressin vs aprotinin, Outcome 3 All‐cause mortality.
4.4
4.4. Analysis
Comparison 4 Desmopressin vs aprotinin, Outcome 4 All thrombotic events (including myocardial infarction, ischaemic stroke, other arterial thromboembolism, and venous thromboembolism).
4.5
4.5. Analysis
Comparison 4 Desmopressin vs aprotinin, Outcome 5 Myocardial infarction.
4.6
4.6. Analysis
Comparison 4 Desmopressin vs aprotinin, Outcome 6 Stroke.
4.7
4.7. Analysis
Comparison 4 Desmopressin vs aprotinin, Outcome 7 Venous thromboembolism.
4.8
4.8. Analysis
Comparison 4 Desmopressin vs aprotinin, Outcome 8 Clinically significant hypotension.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Marquez 1992 {published data only}
    1. Marquez J, Koehler S, Strelec SR, Benckart DH, Spero JA, Cottington EM, et al. Repeated dose administration of desmopressin acetate in uncomplicated cardiac surgery: a prospective, blinded, randomized study. Journal of Cardiothoracic and Vascular Anesthesia 1992;6(6):674‐6. - PubMed
Mongan 1992a {published data only}
    1. Mongan PD, Hosking MP. The role of desmopressin acetate in patients undergoing coronary artery bypass surgery. A controlled clinical trial with thromboelastographic risk stratification. Anesthesiology 1992b;77(1):38‐46. - PubMed
Mongan 1992b {published data only}
    1. Mongan PD, Hosking MP. The role of desmopressin acetate in patients undergoing coronary artery bypass surgery. A controlled clinical trial with thromboelastographic risk stratification. Anesthesiology 1992;77(1):38‐46. - PubMed
Oliver 2000 {published data only}
    1. Oliver WC Jr, Santrach PJ, Danielson GK, Nuttall GA, Schroeder DR, Ereth MH. Desmopressin does not reduce bleeding and transfusion requirements in congenital heart operations. Annals of Thoracic Surgery 2000;70(6):1923‐30. - PubMed
Ozkisacik 2001 {published data only}
    1. Ozkisacik E, Islamoglu F, Posacioglu H, Yagdi T, Basarir S, Omay SB, et al. Desmopressin usage in elective cardiac surgery. Journal of Cardiovascualr Surgery (Torino) 2001;42(6):741‐7. - PubMed
Pleym 2004 {published data only}
    1. Pleym H, Stenseth R, Wahba A, Bjella L, Tromsdal A, Karevold A, et al. Prophylactic treatment with desmopressin does not reduce postoperative bleeding after coronary surgery in patients treated with aspirin before surgery. Anesthesia and Analgesia 2004;98(3):578‐84. - PubMed
Reich 1991 {published data only}
    1. Reich DL, Hammerschlag BC, Rand JH, Weiss‐Bloom L, Perucho H, Galla J, et al. Desmopressin acetate is a mild vasodilator that does not reduce blood loss in uncomplicated cardiac surgical procedures. Journal of Cardiothoracic and Vascular Anesthesia 1991;5(2):142‐5. - PubMed
Reynolds 1993 {published data only}
    1. Reynolds LM, Nicolson SC, Jobes DR, Steven JM, Norwood WI, McGonigle ME, et al. Desmopressin does not decrease bleeding after cardiac operation in young children. Journal of Thoracic and Cardiovascular Surgery 1993;106(6):954‐8. - PubMed
Rocha 1988 {published data only}
    1. Rocha E, Cuesta B, Paramo JA, Fernandez J, Hernandez M, Paloma MJ, et al. Can desmopressin acetate reduce bleeding in cardiac surgery with extracorporeal circulation?.. Sangre. 1987; Vol. 32:Abstract 74.
    1. Rocha E, Llorens R, Paramo JA, Arcas R, Cuesta B, Trenor AM. Does desmopressin acetate reduce blood loss after surgery in patients on cardiopulmonary bypass?. Circulation 1988;77(6):1319‐23. - PubMed
Rocha 1994 {published data only}
    1. Hidalgo F, Llorens R, Melero JM, Arroyo JL, Rocha E. Influence of the administration of DDAVP versus aprotinin in the prevention of bleeding after cardiac surgery. Thrombosis Research. 1993; Vol. 70:Abstract C120.
    1. Rocha E, Hidalgo F, Llorens R, Melero JM, Arroyo JL, Paramo JA. Randomized study of aprotinin and DDAVP to reduce postoperative bleeding after cardiopulmonary bypass surgery. Circulation 1994;90(2):921‐7. - PubMed
Salmenpera 1991 {published data only}
    1. Salmenpera M, Kuitunen A, Hynynen M, Heinonen J. Hemodynamic responses to desmopressin acetate after CABG: a double‐blind trial. Journal of Cardiothoracic and Vascular Anesthesia 1991;5(2):146‐9. - PubMed
Salzman 1986 {published data only}
    1. Millard F, Allen G, Salzman EW. Desmopressin acetate to reduce blood loss after cardiac surgery. New England Journal of Medicine 1986;315(13):834‐5. - PubMed
    1. Salzman EW, Weinstein MJ, Weintraub RM, Ware JA, Thurer RL, Robertson L, et al. Treatment with desmopressin acetate to reduce blood loss after cardiac surgery. A double‐blind randomized trial. New England Journal of Medicine 1986;314(22):1402‐6. - PubMed
    1. Weinstein M, Ware JA, Troll J, Salzman E. Changes in von Willebrand factor during cardiac surgery: effect of desmopressin acetate. Blood 1988;71(6):1648‐55. - PubMed
Schott 1995 {published data only}
    1. Schott U, Sollen C, Axelsson K, Rugarn P, Allvin I. Desmopressin acetate does not reduce blood loss during total hip replacement in patients receiving dextran. Acta Anaesthesiolica Scandinavica 1995;39(5):592‐8. - PubMed
Seear 1989 {published data only}
    1. Seear M, Wadsworth L, Sheps S, Montgomery C, Ashmore P. The effect of desmopressin acetate (DDAVP) on post‐operative blood loss after open heart surgery in children. Blood. 1987; Vol. 5:Abstract 380a.
    1. Seear MD, Wadsworth LD, Rogers PC, Sheps S, Ashmore PG. The effect of desmopressin acetate (DDAVP) on postoperative blood loss after cardiac operations in children. Journal of Thoracic and Cardiovascular Surgery 1989;98(2):217‐9. - PubMed
Shao 2015 {published data only}
    1. Effects of desmopressin on blood loss and the quality of the surgical field during endoscopic sinus surgery. ClinicalTrials.gov number: NCT02125188 (accessed 23 May 2017).
    1. Shao H, Kuang LT, Hou WJ, Zhang T. Effect of desmopressin administration on intraoperative blood loss and quality of the surgical field during functional endoscopic sinus surgery: a randomized, clinical trial. BMC Anesthesiology 2015;15:53. - PMC - PubMed
Sheridan 1994 {published data only}
    1. Sheridan DP, Card RT, Pinilla JC, Harding SM, Thomson DJ, Gauthier L, et al. Use of desmopressin acetate to reduce blood transfusion requirements during cardiac surgery in patients with acetylsalicylic‐acid‐induced platelet dysfunction. Canadian Journal of Surgery 1994;37(1):33‐6. - PubMed
Spyt 1990 {published data only}
    1. Spyt TJ, Weerasena NA, Bain WH, Lowe GD, Rumley A. The effects of desmopressin acetate (DDAVP) on haemostasis and blood loss in routine coronary artery bypass surgery: a randomized, double‐blind trial. Perfusion 1990;5(Suppl):57‐61.
    1. Weerasena NA, Spyt TJ, Rumley A, Bain WH, Lowe GD. Randomised, double‐blind, placebo‐controlled trial of desmopressin in routine coronary artery bypass surgery. British Journal of Haematology. 1990; Vol. 76:Abstract 38.
Steinlechner 2011 {published data only}
    1. Steinlechner B, Spannagl M, Quehenberger P, Zeidler P, Jilma B. Patients with severe aortic valve stenosis and impaired platelet function benefit from pre‐operative desmopressin infusion. Journal of Thrombosis and Haemostasis. 2011; Vol. 9:Abstract P‐MO‐530. - PubMed
    1. Steinlechner B, Zeidler P, Base E, Birkenberg B, Ankersmit HJ, Spannagl M, et al. Patients with severe aortic valve stenosis and impaired platelet function benefit from preoperative desmopressin infusion. Annals of Thoracic Surgery 2011;91(5):1420‐6. - PubMed
Temeck 1994 {published data only}
    1. Temeck BK, Bachenheimer LC, Katz NM, Coughlin SS, Wallace RB. Desmopressin acetate in cardiac surgery: a double‐blind, randomized study. Southern Medical Journal 1994;87(6):611‐5. - PubMed
Theroux 1997 {published data only}
    1. Theroux MC, Corddry DH, Tietz AE, Miller F, Peoples JD, Kettrick RG. A study of desmopressin and blood loss during spinal fusion for neuromuscular scoliosis: a randomized, controlled, double‐blinded study. Anesthesiology 1997;87(2):260‐7. - PubMed
Wingate 1992a {published data only}
    1. Wingate GF, Lewis VL Jr, Green D, Wiedrich TA, Koenig WJ. Desmopressin decreases operative blood loss in spinal cord injury patients having flap reconstruction of pelvic pressure sores. Plastic and Reconstructive Surgery 1992;89(2):279‐82. - PubMed
Wingate 1992b {published data only}
    1. Wingate GF, Lewis VL Jr, Green D, Wiedrich TA, Koenig WJ. Desmopressin decreases operative blood loss in spinal cord injury patients having flap reconstruction of pelvic pressure sores (low risk procedures only). Plastic and Reconstructive Surgery 1992;89(2):279‐82. - PubMed
Wong 2003 {published data only}
    1. Wong AY, Irwin MG, Hui TW, Fung SK, Fan ST, Ma ES. Desmopressin does not decrease blood loss and transfusion requirements in patients undergoing hepatectomy. Canadian Journal of Anaesthesia 2003;50(1):14‐20. - PubMed
Zohar 2001 {published data only}
    1. Zohar E, Fredman B, Ellis MH, Ifrach N, Stern A, Jedeikin R. A comparative study of the postoperative allogeneic blood‐sparing effects of tranexamic acid and of desmopressin after total knee replacement. Transfusion 2001;41(10):1285‐9. - PubMed

References to studies excluded from this review

EudraCT Number: 2009‐017265‐33 {published data only}
    1. Invloed van voeding op farmacokinetiek en ‐dynamiek van desmopressine tablet in vergelijking met desmopressine MELT‐vorm. EudraCT Number: 2009‐017265‐33 (accessed 23 May 2017).
Flordal 1993 {published data only}
    1. Flordal PA, Sahlin S. Use of desmopressin to prevent bleeding complications in patients treated with aspirin. The British Journal of Surgery 1993;80(6):723‐4. - PubMed
Forero 2003 {published data only}
    1. Forero CF, Ramirez JH, Rojas G, Sierra JC. Effects of desmopressin on bleeding in patients undergoing surgery to correct scoliosis [Efectos de la desmopresina sobre el sangrado en pacientes sometidos a cirugia para corregir escoliosis]. Revista Colombiana de Ortopedia y Traumatología 2003;17(4):22‐7.
Gandhi 2014 {published data only}
    1. Gandhi CD, Bulsara KR, Fifi J, Kass‐Hout T, Grant RA, Delgado Almandoz JE, et al. Platelet function inhibitors and platelet function testing in neurointerventional procedures. Journal of Neurointerventional Surgery 2014;6(8):567‐77. - PubMed
Haith 1993 {published data only}
    1. Haith LR Jr, Patton ML, Goldman WT, McCutchan KM. Diminishing blood loss during operation for burns. Surgery, Gynecology & Obstetrics 1993;176(2):119‐23. - PubMed
Hansen 1980 {published data only}
    1. Hansen PE, Hansen JH. Desmopressin (DDAVP) in lumbar puncture. British Medical Journal 1980; Vol. 280, issue 6223:1146. - PMC - PubMed
Hooghiemstra 2012 {published data only}
    1. Hooghiemstra E, Rademaker E, Stooker W, Lauwers H, Wester J, Rademaker B. Desmopressin haemostatic therapy during aortic valve replacement for severe aortic valve stenosis: effects on blood‐loss, use of blood products and postoperative recovery. Applied Cardiopulmonary Physiology. 2012:Abstract P‐26.
IRCT2013092114728N1 {published data only}
    1. The effect of desmopressin in reducing bleeding after cardiac surgery in patients receiving antiplatelet drugs in comparison with placebo. Iranian Registry of Clinical Trials number: IRCT2013092114728N1 (accessed 23 May 2017).
IRCT201409304345N3 {published data only}
    1. Effect of desmopressin on bleeding in coronary artery bypass graft surgery patients undergoing cardiopulmonary bypass pump with antiplatelet drugs. Iranian Registry of Clinical Trials number: IRCT201409304345N3 (accessed 23 May 2017).
Johnson 1990 {published data only}
    1. Johnson RG, Murphy JM. The role of desmopressin in reducing blood loss during lumbar fusions. Surgery, Gynecology & Obstetrics 1990;171(3):223‐6. - PubMed
Karger 2012 {published data only}
    1. Karger R, Reuter K, Rohlfs J, Nimsky C, Sure U, Kretschmer V. The Platelet Function Analyzer (PFA‐100) as a screening tool in neurosurgery. ISRN Hematology 2012;2012:839242. - PMC - PubMed
    1. Karger R, Reuter K, Rohlfs J, Sure U, Kretschmer V. The platelet function analyzer (PFA‐100) as a screening tool in neurosurgery. Symposium of the Nederlandse Vereniging voor Thrombose en Hemostase (NVTH). 2010:Abstract P10‐09. - PMC - PubMed
Keyl 2011 {published data only}
    1. Keyl C, Kmitta E, Kueri S, Zietak T, Trenk D. Effects of aspirin and desmopressin on platelet reactivity in patients undergoing cardiac surgery with extracorporeal circulation. Thrombosis and Haemostasis 2011;105(1):113‐21. - PubMed
Kim 2015 {published data only}
    1. Kim JH, Baek CH, Min JY, Kim JS, Kim SB, Kim H. Desmopressin improves platelet function in uremic patients taking antiplatelet agents who require emergent invasive procedures. Annals of Hematology 2015;94(9):1457‐61. - PubMed
Lozano 1999 {published data only}
    1. Lozano M, Escolar G, Bellucci S, Monteagudo J, Pico M, Ordinas A, et al. L‐Deamino (8‐D‐arginine) vasopressin infusion partially corrects platelet deposition on subendothelium in Bernard‐Soulier syndrome: the role of factor VIII. Platelets 1999;10(1):41‐5. - PubMed
Mannucci 1994 {published data only}
    1. Mannucci PM, Carlsson S, Harris AS. Desmopressin, surgery and thrombosis. Thrombosis and Haemostasis 1994; Vol. 71, issue 1:154‐5. - PubMed
Mirmansoori 2016 {published data only}
    1. Mirmansoori A, Farzi F, Sedighinejad A, Imantalab V, Mohammadzadeh A, Atrkar Roushan Z, et al. The effect of desmopressin on the amount of bleeding in patients undergoing coronary artery bypass graft surgery with a cardiopulmonary bypass pump after taking anti‐platelet medicine. Anesthesiology and Pain Medicine 2016;6(5):e39226. - PMC - PubMed
Myrvang 2011 {published data only}
    1. Myrvang H. Biopsy: desmopressin reduces risk of bleeding after percutaneous kidney biopsy. Nature Reviews. Nephrology 2011;7(6):304. - PubMed
NCT00835211 {published data only}
    1. Desmopressin acetate 0.2 mg tablets, fasting. ClinicalTrials.gov number: NCT00835211 (accessed 23 May 2017).
NCT01218074 {published data only}
    1. Platelets Antiaggregation Control Enhancement (PACE) study. ClinicalTrials.gov number: NCT01218074 (accessed 23 May 2017).
NCT01382134 {published data only}
    1. Effect of aspirin, hemodilution and desmopressin on platelet dysfunction. ClinicalTrials.gov number: NCT01382134 (accessed 23 May 2017).
NCT01606072 {published data only}
    1. Perioperative use of desmopressin (DDAVP) in breast cancer. ClinicalTrials.gov number: NCT01606072 (accessed 23 May 2017).
NCT01623206 {published data only}
    1. Desmopressin (DDAVP) in patients with colorectal cancer and rectal bleeding. ClinicalTrials.gov number: NCT01623206 (accessed 23 May 2017).
Nilsen 1984 {published data only}
    1. Nilsen DW, Haerem J, Westheim A, Skjennald A, Grendahl H, Godal HC. Venous thrombosis following diagnostic transvenous catheterization by percutaneous catheter insertion: an evaluation of desmopressin as a thromboprophylactic agent. Thrombosis and Haemostasis 1984;52(2):121‐3. - PubMed
Ozal 2002 {published data only}
    1. Ozal E, Kuralay E, Bingol H, Cingoz F, Ceylan S, Tatar H. Does tranexamic acid reduce desmopressin‐induced hyperfibrinolysis?. The Journal of Thoracic and Cardiovascular Surgery 2002;123(3):539‐43. - PubMed
Palaia 2001 {published data only}
    1. Palaia DA, Rosenberg MH, Bonanno PC. The use of DDAVP desmopressin reduces the incidence of microhematomas after facioplasty. Annals of Plastic Surgery 2001;46(5):463‐6. - PubMed
Spiro 1982 {published data only}
    1. Spiro F, Polakow E. The effect of desmopressin on post‐lumbar puncture/myelography morbidity. South African Medical Journal 1982; Vol. 62, issue 13:428. - PubMed
Stanca 2010 {published data only}
    1. Prevention of bleeding in patients with cirrhosis undergoing dental extraction. ClinicalTrials.gov number: NCT00816127 (accessed 23 May 2017).
    1. Stanca CM, Montazem AH, Lawal A, Zhang JX, Schiano TD. Intranasal desmopressin versus blood transfusion in cirrhotic patients with coagulopathy undergoing dental extraction: a randomized controlled trial. Journal of Oral and Maxillofacial Surgery 2010;68(1):138‐43. - PubMed
    1. Stanca CM, Montazem AH, Zhang JH, Lawal A, Schiano TD. Intranasal desmopressin is effective in preventing bleeding after dental extraction in cirrhotic patients having moderate degrees of coagulopathy. Hepatology. 2007; Vol. 46:Abstract 568A.
Weinberg 2015 {published data only}
    1. Weinberg RS, Grecco MO, Ferro GS, Seigelshifer DJ, Perroni NV, Terrier FJ, et al. A phase II dose‐escalation trial of perioperative desmopressin (1‐desamino‐8‐d‐arginine vasopressin) in breast cancer patients. SpringerPlus 2015;4:428. - PMC - PubMed
Zielske 2003 {published data only}
    1. Zielske D, Seyfert UT, Heim MU, Mrowietz C, Jung F. Effects of desmopressin on the primary haemostasis impaired by clopidogrel. Annals of Hematology. 2003; Vol. 82:Abstract 338.
Zotz 2009 {published data only}
    1. Zotz RB. A stratified metaanalysis of desmopressin (DDAVP) for minimising perioperative allogeneic blood transfusion. Blood. 2009; Vol. 114:Abstract 1306.

References to studies awaiting assessment

Jahangirifard 2017 {published data only}
    1. Comparison of desmopressin with placebo, in hemostasis after heart transplant surgery. Iranian Registry of Clinical Trials number: IRCT2015010512642N8 (accessed 23 May 2017).
    1. Jahangirifard A, Razavi MR, Ahmadi ZH, Forozeshfard M. The effect of desmopressin on the amount of bleeding and transfusion requirements in patients undergoing heart transplant surgery. Basic & Clinical Pharmacology & Toxicology 2017:epub ahead of print. [DOI: 10.1111/bcpt.12780] - DOI - PubMed

References to ongoing studies

ISRCTN12845429 {published data only}
    1. DRIVE ‐ Desmopressin for procedures or radiological interventions. ISRCTN number: ISRCTN12845429 (accessed 23 May 2017).
NCT00885924 {published data only}
    1. Desmopressin as treatment for postoperative bleeding after cardiac surgery. ClinicalTrials.gov number: NCT00885924 (accessed 23 May 2017).
NCT01982760 {published data only}
    1. DDAVP in the reduction of post‐operative ecchymosis in rhinoplasty. ClinicalTrials.gov number: NCT01982760 (accessed 23 May 2017).
NCT02084342 {published data only}
    1. Study of DDAVP combined with TXA on the blood loss and transfusion need during and after scoliosis correction surgery. ClinicalTrials.gov number: NCT02084342 (accessed 23 May 2017).

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