title: Effects on coagulation and fibrinolysis of desmopressin in patients undergoing total hip replacement.
abstract: 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.
authors.affiliation: Department of Surgery, Danderyd Hospital, Sweden.
authors.forename: P A
authors.initials: PA
authors.lastname: Flordal
authors.forename: K G
authors.initials: KG
authors.lastname: Ljungström
authors.forename: J
authors.initials: J
authors.lastname: Svensson
authors.forename: B
authors.initials: B
authors.lastname: Ekman
authors.forename: G
authors.initials: G
authors.lastname: Neander
mesh_terms: 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
chemical_list: D000941:Antigens; D015849:Plasminogen Inactivators; C029417:Von Willebrand antigen; D014841:von Willebrand Factor; D000990:Antithrombin III; D005169:Factor VIII; D003894:Deamino Arginine Vasopressin