title: The effect of desmopressin on blood loss in patients with rheumatoid arthritis undergoing hip arthroplasty.
abstract: BACKGROUND
  Blood loss is an important issue for patients with rheumatoid arthritis undergoing hip surgery. We hypothesised that intraoperative desmopressin treatment would result in a reduction in blood loss in rheumatoid patients undergoing total hip arthroplasty.
  
  
  METHODS
  Seventy-five patients scheduled for elective total hip arthroplasty were randomised to three groups to receive 0.4 microg/kg desmopressin (D 0.4), 0.2 microg/kg desmopressin (D 0.2) or placebo intraoperatively in a double-blind fashion. Blood transfusions were based on calculated safe allowable blood loss and haemoglobin measurements (trigger 90 g/l, 5.59 mmol/l). The primary endpoint was the total blood loss measured till the end of the fourth post-operative day. Secondary endpoints included red cell transfusion requirements and haemoglobin.
  
  
  RESULTS
  Total blood loss during the study period was not significantly different between the groups (D 0.4 1829 +/- 1068; D 0.2 2240 +/- 843 and placebo 2254 +/- 1040 ml; P= 0.50). The total amount of red cell transfusions was fewer in group D 0.4 (3.6 +/- 1.6 U) when compared with D 0.2 (4.4 +/- 1.7 U; P=0.009) and placebo (4.5 +/- 2.0 U; P= 0.011) groups. Haemoglobin concentration was lower in the placebo group in the first (5.42 +/- 1.16 vs. 5.98 +/- 0.47 mmol/l; P=0.033) and the second (6.28 +/- 0.66 vs. 6.69 +/- 0.47 mmol/l; P=0.033) post-operative mornings compared with group D 0.4.
  
  
  CONCLUSIONS
  Despite a lack of difference in the primary outcome, total blood loss, intraoperative administration of 0.4 microg/kg desmopressin resulted in fewer total red cell transfusion requirements in rheumatoid patients undergoing total hip arthroplasty when compared with 0.2 microg/kg treatment and placebo.
authors.affiliation: Department of Anaesthesiology, Turku University Hospital, Turku, Finland. kari.leino@tyks.fi
authors.forename: K A
authors.initials: KA
authors.lastname: Leino
authors.forename: H K
authors.initials: HK
authors.lastname: Pälve
authors.forename: H T
authors.initials: HT
authors.lastname: Tiusanen
authors.forename: T T
authors.initials: TT
authors.lastname: Tuppurainen
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003894:Deamino Arginine Vasopressin / Q000494:pharmacology*; D004311:Double-Blind Method; D023381:Endpoint Determination; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011183:Postoperative Complications / Q000453:epidemiology; D020246:Venous Thrombosis / Q000150:complications / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D003894:Deamino Arginine Vasopressin