Effects on coagulation and fibrinolysis of desmopressin in patients undergoing total hip replacement.
Twelve patients undergoing total hip replacement, with regional anaesthesia and with dextran infusion for plasma expansion and thromboprophylaxis, were given the vasopressin analogue desmopressin (DDAVP) or placebo in a randomized, double-blind prospective study. In controls (n = 6) we found a prolongation of the bleeding time, low factor VIII (FVIII) and von Willebrand factor (vWF) and a decrease in antithrombin III to levels known to be at risk for venous thrombosis. Desmopressin shortened postoperative bleeding time, gave an early FVIII/vWF complex increase, prevented antithrombin III from falling to critically low values and appeared to activate the fibrinolytic system, both by tPA increase and PAI-1 decrease. Thus in the controls we found changes in both coagulation and fibrinolysis indicating a haemorrhagic diathesis as well as a risk for thromboembolism. Desmopressin induced factor changes that possibly reduce both risks.
Flordal
P A
PA
Department of Surgery, Danderyd Hospital, Sweden.
Ljungström
K G
KG
Svensson
J
J
Ekman
B
B
Neander
G
G
D000328:Adult; D000368:Aged; D000941:Antigens / Q000378:metabolism; D000990:Antithrombin III / Q000378:metabolism; D001777:Blood Coagulation / Q000187:drug effects*; D003894:Deamino Arginine Vasopressin / Q000494:pharmacology*; D004311:Double-Blind Method; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D015849:Plasminogen Inactivators / Q000378:metabolism; D010976:Platelet Count / Q000187:drug effects; D011446:Prospective Studies; D014841:von Willebrand Factor / Q000276:immunology
D000941:Antigens; D015849:Plasminogen Inactivators; C029417:Von Willebrand antigen; D014841:von Willebrand Factor; D000990:Antithrombin III; D005169:Factor VIII; D003894:Deamino Arginine Vasopressin