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Desmopressin use for minimising perioperative allogeneic blood transfusion

  • Review
  • Intervention

Authors


Abstract

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

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.

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