Does arginine vasopressin influence the coagulation system in advanced vasodilatory shock with severe multiorgan dysfunction syndrome?
Arginine vasopressin (AVP) is a potent supplementary vasopressor in advanced vasodilatory shock, but decreases in platelet count have been reported during AVP therapy. In this study we evaluated the effects of AVP infusion on the coagulation system in advanced vasodilatory shock when compared to norepinephrine (NE) infusion alone. Forty-two patients with advanced vasodilatory shock (NE requirements >0.5 microg x kg(-1) x min(-1), mean arterial blood pressure <70 mm Hg) were prospectively randomized to receive an additional AVP infusion (4 U/h) or NE infusion alone. Most patients received coagulation active treatment (fresh-frozen plasma, thrombocyte concentrates, coagulation factors, and continuous veno-venous hemofiltration with heparin). At baseline and 1, 24, and 48 h after randomization, coagulation laboratory variables and a modified thrombelastography were measured. There were no differences between groups in plasmatic coagulation variables. Although there was no significant difference between groups, platelet count significantly decreased in AVP patients (P = 0.036). There were no differences in results of modified thrombelastography analyses between groups. AVP infusion in advanced vasodilatory shock with severe multiorgan dysfunction syndrome does not increase plasma concentrations of Factor VIII, von Willebrand Factor antigen, and ristocetin Co-Factor but may stimulate platelet aggregation and induce thrombocytopenia. Global coagulation, assessed by modified thrombelastography, is not different from patients receiving NE infusion alone.
*Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, and the †Institute of Medical Biostatistics, The University of Innsbruck, Innsbruck, Austria.
Martin W
MW
Dünser
Dietmar R
DR
Fries
Wolfgang
W
Schobersberger
Hanno
H
Ulmer
Volker
V
Wenzel
Barbara
B
Friesenecker
Walter R
WR
Hasibeder
Andreas J
AJ
Mayr
D000368:Aged; D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D016638:Critical Illness; D004338:Drug Combinations; D023381:Endpoint Determination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006440:Hemofiltration; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009102:Multiple Organ Failure / Q000150:complications / Q000503:physiopathology*; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012769:Shock / Q000150:complications / Q000188:drug therapy*; D013916:Thrombelastography; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014664:Vasodilation / Q000187:drug effects* / Q000502:physiology
D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D009638:Norepinephrine