Desmopressin use for minimising perioperative allogeneic blood transfusion
Editorial Group: Cochrane Injuries Group
Published Online: 26 JAN 2004
Assessed as up-to-date: 20 APR 2008
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Carless PA, Stokes BJ, Moxey AJ, Henry DA. Desmopressin use for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001884. DOI: 10.1002/14651858.CD001884.pub2.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 26 JAN 2004
Public concerns regarding the safety of blood have prompted reconsideration of the use of allogeneic blood (blood from an unrelated donor) transfusion and a range of techniques designed to minimise transfusion requirements.
To examine the efficacy of desmopressin acetate (1-deamino-8-D-arginine-vasopressin) in reducing peri-operative blood loss and the need for red blood cell (RBC) transfusion in patients who do not have congenital bleeding disorders.
We identified studies by searching CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (1950 to 2008), EMBASE (1980 to 2008), the Internet (to May 2008), and bibliographies of published articles.
Controlled parallel-group trials in which adult patients scheduled for non-urgent surgery were randomised to desmopressin (DDAVP) or to a control group that did not receive DDAVP treatment. Trials were eligible for inclusion if they reported data on the number of patients exposed to allogeneic red cell transfusion or the volume of blood transfused.
Data collection and analysis
Primary outcomes were: the number of patients exposed to allogeneic red blood cell (RBC) transfusion, and the amount of blood transfused. Other outcomes measured were: blood loss, re-operation for bleeding, post-operative complications (thrombosis, myocardial infarction, stroke), mortality, and length of hospital stay. Treatment effects were pooled using a random-effects model.
Nineteen trials that included a total of 1387 patients reported data on the number of patients exposed to allogeneic RBC transfusion. DDAVP did not significantly reduce the risk of exposure to allogeneic RBC transfusion (relative risk (RR) 0.96, 95% confidence interval (CI) 0.87 to 1.06). However, the use of DDAVP significantly reduced total blood loss (weighted mean difference (WMD) -241.78 ml, 95% CI -387.55 to -96.01 ml). 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). Risk of re-operation due to bleeding was not reduced (RR 0.69, 95% CI 0.26 to 1.83). DDAVP treatment was not associated with an increased risk of death or myocardial infarction (RR 1.72, 95% CI 0.68 to 4.33; RR 1.38, 95% CI 0.77 to 2.50, respectively).
There is no convincing evidence that desmopressin (DDAVP) minimises peri-operative allogeneic RBC transfusion in patients who do not have congenital bleeding disorders. Although the data suggest that there is some benefit of using DDAVP as a means of reducing peri-operative blood loss the observed reductions were small and generally not clinically important. Based on the currently available evidence, the use of DDAVP to reduce peri-operative blood loss or allogeneic RBC transfusion cannot be supported.
Plain language summary
Use of desmopressin to reduce the need for blood transfusions in patients who do not suffer from congenital bleeding disorders.
Risks of infection from transfused blood given by an unrelated donor are minimal when blood is screened by a competent transfusion service but concerns still remain. Techniques are available to reduce the need for a transfusion. The review of trials found that there is no convincing evidence that desmopressin reduces the need for blood transfusion in patients who do not have congenital bleeding disorders and are undergoing non-urgent or elective surgery. Other strategies, such as the use of anti-fibrinolytic drugs, may be more effective but are not included in this review.
評估desmopressin acetate (1deamino8Dargininevasopressin；DDAVP)對於減少非先天性出血疾病患者其術中失血及需要紅血球輸血效益的證據。
經由下列資料庫確定文章：電腦檢索 MEDLINE，EMBASE，Current Contents (to May 2003)，及the Cochrane Central Register of Controlled Trials (CENTRAL) (考科藍圖書館，2003年，第1期)。檢索確定試驗與回顧文章的參考文獻，並聯絡作者以確定其他的研究。
採用Schulz等(Schulz 1995)與Jadad等(Jadad 1996)建議的標準來評估試驗品質。主要的測量結果為：病患接受異體紅血球輸血的人數及輸血量。其他的測量結果為：因為出血而再手術，失血量，術後併發症(血栓，感染，非致死性的心肌梗塞)，死亡率，及住院天數(LOS)。
18篇DDAVP的試驗(n = 1295)報告病患異體紅血球輸血人數的資料。以DDAVP治療的研究對象其暴露於術中異體輸血的pooled relative risk為0.95 (95%CI = 0.86至1.06)。使用DDAVP不會顯著減少失血量；weighted mean difference (WMD) = −114.3ml: 95% confidence interval (95%CI) = 每名病患−258.8至30.2ml)或RBC輸血量 (WMD = −0.35單位: 95%CI = −0.70至0.01單位)。以DDAVP治療的病患其因為出血而需要再手術的relative risk為0.69 (95%CI = 0.26至1.83)。整體來說，相較於對照組，以DDAVP治療的病患其死亡率及非致死性心肌梗塞沒有統計上顯著的影響(RR = 1.72: 95%CI = 0.68至4.33)及(RR = 1.38: 95%CI = 0.77至2.50)。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。