Intervention Review

Desmopressin use for minimising perioperative allogeneic blood transfusion

  1. Paul A Carless1,*,
  2. Barrie J Stokes1,
  3. Annette J Moxey1,
  4. David A Henry2

Editorial Group: Cochrane Injuries Group

Published Online: 26 JAN 2004

Assessed as up-to-date: 20 APR 2008

DOI: 10.1002/14651858.CD001884.pub2


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.

Author Information

  1. 1

    Faculty of Health, University of Newcastle, Discipline of Clinical Pharmacology, Newcastle, New South Wales, Australia

  2. 2

    Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada

*Paul A Carless, Discipline of Clinical Pharmacology, Faculty of Health, University of Newcastle, Level 5, Clinical Sciences Building, Newcastle Mater Hospital, Edith Street, Waratah, Newcastle, New South Wales, 2298, Australia. Paul.Carless@newcastle.edu.au.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 26 JAN 2004

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

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.

Search methods

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.

Selection criteria

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.

Main results

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).

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Desmopressin用於減少術中異體輸血

大眾關心輸血的安全性,這促使重新考慮異體紅血球輸血(血液來自不相關的捐贈者)的跡象,並設計一系列的技術以減少輸血需要。

目標

評估desmopressin acetate (1deamino8Dargininevasopressin;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。

搜尋策略

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。

選擇標準

預定非緊急手術的成年患者被隨機分配到DDAVP或沒有接受介入措施之對照組的對照平行組試驗。

資料收集與分析

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)。

主要結論

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)。

作者結論

沒有關於desmopressin對於減少非先天性出血疾病患者其術中異體紅血球輸血的可信證據。這些資料認為使用DDAVP作為減少術中異體紅血球輸血的方法沒有效益。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有關於desmopressin減少非先天性出血疾病患者其需要輸血的可信證據。當經由適當的輸血服務篩檢血液時,從不相關捐贈者的血液輸血而感染的風險不大,但仍需要高度關注這個問題。目前有其他的技術可用來減少輸血的需要。回顧試驗發現沒有關於desmopressin減少非先天性出血疾病之擇期手術病患其需要輸血的可信證據。其他的策略,如使用抗纖維蛋白溶解藥物也許是比較有效的。