title: The effects of desmopressin and 6% hydroxyethyl starch on factor VIII:C.
abstract: In moderate doses of 20 mL/kg (1.2 g/kg), hydroxyethyl starch (HES) 6% decreases factor VIII:C activity. Desmopressin (DDAVP) increases circulating levels of factor VIII:C by stimulating the release of factor VIII:C from peripheral storage sites. The objective of this study was to monitor the changes in factor VIII:C associated with sequential HES and DDAVP administration. Thirty patients undergoing surgical procedures with a predicted blood loss of less than 750 mL were enrolled. After induction of anesthesia, HES was administered, 20 mL/kg, to a maximum of 1500 mL, at a rate to meet intraoperative fluid requirements. Patients then randomly received either a 10-mL solution containing 0.3 microgram/kg of DDAVP (Group 1) or 10 mL of normal saline (Group 2). After HES administration, factor VIII:C levels decreased significantly, to 69% of baseline, in both groups. After study drug administration, factor VIII:C in Group 1 increased significantly to 135% of baseline at 30 min and 115% of baseline at 60 min while in Group 2 average factor VIII:C levels remained below baseline at 30 and 60 min. DDAVP produced an increase in factor VIII:C activity despite HES administration and should be considered a treatment option for the mild coagulopathy infrequently associated with HES administration.
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston 29425-2207, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Conroy
authors.forename: R L
authors.initials: RL
authors.lastname: Fishman
authors.forename: S T
authors.initials: ST
authors.lastname: Reeves
authors.forename: M L
authors.initials: ML
authors.lastname: Pinosky
authors.forename: J
authors.initials: J
authors.lastname: Lazarchick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005169:Factor VIII / Q000032:analysis*; D005340:Fibrinogen / Q000032:analysis; D005440:Fluid Therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007430:Intraoperative Care; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000627:therapeutic use*; D010976:Platelet Count; D012076:Renal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012965:Sodium Chloride
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012076:Renal Agents; D012965:Sodium Chloride; D005169:Factor VIII; D005340:Fibrinogen; D003894:Deamino Arginine Vasopressin