Desmopressin for minimising perioperative allogeneic blood transfusion.
BACKGROUND
Public concerns regarding the safety of transfused blood have prompted re-consideration of the use of allogeneic (from an unrelated donor) red blood cell (RBC) transfusion, and a range of techniques designed to minimise transfusion requirements.


OBJECTIVE
To examine the evidence for the efficacy of desmopressin (1-deamino-8-D-arginine-vasopressin), in reducing perioperative blood loss and the need for red cell transfusion in patients who do not have congenital bleeding disorders.


METHODS
Articles were identified by: computer searches of OVID MEDLINE, EMBASE, and Current Contents (to August 2000) and web sites of international health technology assessment agencies (to May 1998). References in the identified trials and review articles were checked and authors contacted to identify additional studies.


METHODS
Randomised controlled parallel group trials in which adult patients, scheduled for non-urgent surgery, were randomised to DDAVP, or to a control group, who did not receive the intervention.


METHODS
Trial quality was assessed using criteria proposed by Schulz et al. (1995) and Jadad et al. (1996). The principal outcomes were: the number of patients exposed to red cells, and the amount of blood transfused. Other clinical outcomes are detailed in the review.


RESULTS
Fourteen trials of DDAVP (N=1034) reported data on the proportion of patients exposed to allogeneic RBC transfusion. In subjects treated with DDAVP the relative risk of exposure to peri-operative allogeneic blood transfusion was 0.98 (95%CI: 0.88 to 1.10) compared with control. In DDAVP-treated patients the relative risk of requiring re-operation due to bleeding was 0.56 (95%CI: 0.18 to 1.73). There was no statistically significant effect overall for mortality and non-fatal myocardial infarction in DDAVP-treated patients compared with control (RR=1.53: 95%CI: 0.58 to 4.05) and (RR=1.52: 95%CI: 0.67 to 3.49) respectively.


CONCLUSIONS
There is no convincing evidence that desmopressin minimises perioperative allogeneic RBC transfusion in patients who do not have congenital bleeding disorders. These data suggest that there is no benefit of using DDAVP as a means of minimising perioperative allogeneic RBC transfusion. This meta-analysis had 90% power to detect a relative risk reduction of at least 17% for receiving a red cell transfusion at alpha = 0.05 (two-sided).
Henry
D A
DA
Discipline of Clinical Pharmacology, Faculty of Medicine and Health Sciences, The University of Newcastle, Newcastle Mater Hospital, Edith St Waratah, Newcastle, New South Wales, Australia, 2298. mddah@mail.newcastle.edu.au
Moxey
A J
AJ
Carless
P A
PA
O'Connell
D
D
McClelland
B
B
Henderson
K M
KM
Sly
K
K
Laupacis
A
A
Fergusson
D
D
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014184:Transplantation, Homologous
D006490:Hemostatics; D003894:Deamino Arginine Vasopressin