1
|
Rodgers RPC, Levin J. A Critical Reappraisal of the Bleeding Time. Semin Thromb Hemost 2024; 50:499-516. [PMID: 38086409 DOI: 10.1055/s-0043-1777307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Seminars in Thrombosis and Hemostasis (STH) celebrates 50 years of publishing in 2024. To celebrate this landmark event, STH is republishing some archival material. This manuscript represents the second most highly cited paper ever published in STH. The manuscript published without an abstract, and essentially represented a State of the Art Review on the bleeding time, a relatively invasive procedure that required an incision on the skin or earlobe of a patient, and timing how long it took for the incision to stop bleeding. The bleeding time test was first described in 1901 by the French physician Milian, who presented three studies of bleeding from stab wounds made in the fingertips of healthy and diseased subjects. In 1910, Duke observed the duration of bleeding from small incisions of the ear lobe, and pointed out that the duration of bleeding was increased in instances of reduced platelet counts. The test was subsequently repeatedly modified, and numerous variants of the test, including semiautomated methods, were described by several workers. The most frequently utilised test reflected one described by Ivy and coworkers, who shifted the location of the incision to the volar aspect of the forearm and applied a blood pressure cuff to the arm to maintain a standard venous pressure. The bleeding time has been proposed for use as a diagnostic test for platelet-related bleeding disorders, a measure of efficacy in various forms of therapy, and as a prognosticator of abnormal bleeding. The authors to the current review reevaluated the bleeding time literature using methods to assess the performance of the test in 1990, locating 862 printed documents that discussed the bleeding time, the majority in peer-reviewed professional journals. As this is a republication of archival material, transformed into a modern format, we apologise in advance for any errors introduced during this transformation.
Collapse
Affiliation(s)
- R P Channing Rodgers
- Department of Laboratory Medicine, School of Medicine, University of California, San Francisco, California
- The Veterans Administration Medical Center, San Francisco, California
| | - Jack Levin
- Department of Laboratory Medicine, School of Medicine, University of California, San Francisco, California
- The Veterans Administration Medical Center, San Francisco, California
| |
Collapse
|
2
|
Mohinani A, Patel S, Tan V, Kartika T, Olson S, DeLoughery TG, Shatzel J. Desmopressin as a hemostatic and blood sparing agent in bleeding disorders. Eur J Haematol 2023; 110:470-479. [PMID: 36656570 PMCID: PMC10073345 DOI: 10.1111/ejh.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Intranasal, subcutaneous, or intravenous desmopressin can be utilized to release von Willebrand Factor and Factor VIII into circulation, enhance platelet adhesion and shorten bleeding time. Due to these properties, desmopressin can be effective in controlling bleeding in mild hemophilia A, certain subtypes of von Willebrand disease and in acute bleeding from uremia, end stage renal disease, and liver disease. Its use, however, can be complicated by hyponatremia and rarely arterial thrombotic events. While desmopressin has also been used as a prophylactic blood sparing agent in orthopedic, renal, and hepatic procedures, clinical studies have shown limited benefit in these settings. The purpose of this article is to review the evidence for desmopressin in primary hematologic disorders, discuss its mechanism of action and evaluate its utility as a hemostatic and blood sparing product in various bleeding conditions.
Collapse
Affiliation(s)
- Ajay Mohinani
- Division of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Sarah Patel
- Division of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Virginia Tan
- Division of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas Kartika
- Division of Hematology & Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sven Olson
- Division of Hematology & Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas G. DeLoughery
- Division of Hematology & Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph Shatzel
- Division of Hematology & Oncology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
3
|
Jahangirifard A, Mirtajani SB, Madadi F. Effect of Desmopressin on Bleeding After Heart Surgeries: A Narrative Review. Anesth Pain Med 2023; 13:e133894. [PMID: 37645010 PMCID: PMC10461384 DOI: 10.5812/aapm-133894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 08/31/2023] Open
Abstract
Desmopressin is an analog of the antidiuretic hormone (vasopressin), which causes anticoagulant activity by increasing plasma factor 8. The use of desmopressin dates back to 1977, when this hormone was used to prevent bleeding during tooth extraction and surgery in patients with hemophilia A and von Willebrand disease. After that, this hormone was expanded to prevent bleeding in congenital defects and conditions such as chronic kidney and liver failure. Also, this hormone is used to prevent bleeding in major surgeries such as heart surgery, where the patient loses much blood and needs a blood transfusion. Considering the importance of desmopressin in bleeding control, the present study was conducted to investigate the possible effect of this hormone in heart surgery.
Collapse
Affiliation(s)
- Alireza Jahangirifard
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Bashir Mirtajani
- Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Firoozeh Madadi
- Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Schultz-Lebahn A, Nissen PH, Pedersen TF, Tang M, Hvas AM. Platelet function assessed by ROTEM ® platelet in patients receiving antiplatelet therapy during cardiac and vascular surgery. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 82:18-27. [PMID: 34890293 DOI: 10.1080/00365513.2021.2012820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients undergoing coronary artery bypass graft (CABG) surgery or carotid endarterectomy (CEA) continue antiplatelet therapy perioperatively, which may increase bleeding risk. We aimed to investigate whether Rotational thromboelastometry (ROTEM®) platelet, a newly marketed platelet function analysis, would detect antiplatelet therapy in CABG and CEA patients; whether detection of reduced platelet function was associated with increased bleeding; and whether ex vivo desmopressin increased platelet function. We included 20 CABG patients continuing aspirin and 20 CEA patients continuing clopidogrel (n = 1) or clopidogrel and aspirin (n = 19). Platelet function was analyzed with ROTEM® platelet and light transmission aggregometry (LTA). According to the lower reference limit, ROTEM® platelet managed to detect aspirin, but clopidogrel detection was inadequate compared to LTA. Using a previously published cut-off for bleeding risk, 6 (30%) patients receiving aspirin and 4 (21%) patients receiving both clopidogrel and aspirin demonstrated platelet function below this cut-off. One of the four CEA patients below the cut-off died from intracerebral hemorrhage postoperatively. CABG patients below (n = 6) and above (n = 14) the cut-off did not differ in chest tube output (median [range]: 373 ml [250-900] vs. 368 ml [195-820]). Ex vivo addition of desmopressin did not increase platelet function. In conclusion, ROTEM® platelet does reveal aspirin treatment whereas clopidogrel treatment is most often overlooked. Due to low bleeding in the study population, it was not possible to conclude on the association with bleeding risk.
Collapse
Affiliation(s)
- Anna Schultz-Lebahn
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Peter H Nissen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Troels Fogh Pedersen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
5
|
Abstract
Acquired von Willebrand syndrome can occur in the setting of myeloproliferative neoplasms; plasma cell dyscrasias and other lymphoproliferative disorders; autoimmune conditions; and causes of increased shear forces, such as aortic stenosis or other structural heart disease and mechanical circulatory support. The depletion of von Willebrand factor, especially high-molecular-weight multimers, can lead to mucocutaneous bleeding and the formation of arteriovenous malformations, particularly in the gastrointestinal tract. Management focuses on correction of the underlying cause when possible, but may include intravenous immunoglobulins, von Willebrand factor concentrate, rituximab, or antiangiogenic therapy depending on the clinical context.
Collapse
Affiliation(s)
- Arielle L Langer
- Division of Hematology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Nathan T Connell
- Division of Hematology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| |
Collapse
|
6
|
Stubbs J, Klompas A, Thalji L. Transfusion Therapy in Specific Clinical Situations. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
7
|
Rhee SH, An JS, Seo KS, Karm MH. Predictors of Red Blood Cell Transfusion in Bimaxillary Orthognathic Surgery: A Retrospective Study. Int J Med Sci 2021; 18:1432-1441. [PMID: 33628100 PMCID: PMC7893559 DOI: 10.7150/ijms.55567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/07/2021] [Indexed: 01/28/2023] Open
Abstract
Background: Orthognathic surgery requires red blood cell (RBC) transfusions more frequently than other oral and maxillofacial surgeries. The purpose of this study was to identify reliable predictors for RBC transfusion during bimaxillary orthognathic surgery (BOS). Methods: This retrospective study reviewed 1,616 electronic medical records of patients who underwent BOS during a 5-year period at Seoul National University Dental Hospital. The perioperative variable data were collected from electronic medical records and analyzed by dividing patients into the two groups (non-transfusion and transfusion group). Results: Of the 1,616 patients, 1,311 patients were excluded. The remaining 305 patients were divided into non-transfusion (NTF, n = 256) and transfusion (TF, n = 49) groups. Univariate logistic regression analysis revealed that age, body mass index, the presence of several adjunctive surgeries (including genioplasty, extraction, and mandibular angle reduction), preoperative hemoglobin (Hb) and prothrombin time, surgical time, amount of fluid infusion and blood loss, and mean pulse rate during surgery were significant factors predicting RBC transfusion. Multivariate logistic regression analysis revealed that preoperative Hb and blood loss amount during surgery were significantly related to RBC transfusion in BOS patients. Conclusion: Since blood loss amounts could not be measured preoperatively, we found that the independent predictor associated with RBC transfusion during BOS was a low preoperative Hb level.
Collapse
Affiliation(s)
- Seung-Hyun Rhee
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Jung-Sub An
- Department of Orthodontics, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| |
Collapse
|
8
|
Steinlechner B, Zeidler P, Dworschak M, Base E, Birkenberg B, Ankersmit HJ, Spannagl M, Quehenberger P, Hiesmayr M, Jilma B. Corrigendum to “Patients With Severe Aortic Valve Stenosis and Impaired Platelet Function Benefit From Preoperative Desmopressin Infusion” [Ann Thorac Surg 91 (2011) 1420-1426]. Ann Thorac Surg 2020. [DOI: 10.1016/j.athoracsur.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Athavale A, Kulkarni H, Arslan CD, Hart P. Desmopressin and bleeding risk after percutaneous kidney biopsy. BMC Nephrol 2019; 20:413. [PMID: 31730448 PMCID: PMC6858772 DOI: 10.1186/s12882-019-1595-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/16/2019] [Indexed: 01/17/2023] Open
Abstract
Background Desmopressin is used to reduce bleeding after kidney biopsy but evidence supporting its use is weak, especially in patients with elevated creatinine. The present study was undertaken to evaluate efficacy of desmopressin in reducing bleeding after percutaneous kidney biopsy. Methods Retrospective cohort study. 269 of 322 patients undergoing percutaneous kidney biopsy between January 1, 2014 and January 31, 2018 were included. Patients had normal bleeding time, platelet count and coagulation profile. Primary outcome was defined as composite of hemoglobin drop ≥1 g/dL, hematoma on post biopsy ultrasound, gross hematuria, erythrocyte transfusion or angiography to stop bleeding. Association of desmopressin with outcomes was assessed using linear (for continuous variables) and logistic (for binary variables) regression models. Propensity score was used to minimize potential confounding. Results Desmopressin was administered to 100/269 (37.17%) patients. After propensity score adjustment patients who received desmopressin had increased odds of post biopsy bleeding [OR 3.88 (1.95–7.74), p < 0.001]. Creatinine at time of biopsy influenced bleeding risk; gender, emergent vs elective biopsy, obesity, AKI, diabetes, hypertension or bleeding time did not influence bleeding risk. Administration of desmopressin to patients with serum creatinine ≥1.8 mg/dL decreased bleeding risk [OR 2.11 (95% CI 0.87–5.11), p = 0.09] but increased bleeding risk when serum creatinine was < 1.8 mg/dL (OR 9.72 (95% CI 2.95–31.96), p < 0.001). Conclusion Desmopressin should not be used routinely prior to percutaneous kidney biopsy in patients at low risk for bleeding but should be reserved for patients who are at high risk for bleeding.
Collapse
Affiliation(s)
- Ambarish Athavale
- Division of Nephrology, Cook County Health, 1950 W. Polk Street, 5th Floor, Chicago, IL, 60605, USA.
| | | | - Cagil D Arslan
- Division of Nephrology, Cook County Health, 1950 W. Polk Street, 5th Floor, Chicago, IL, 60605, USA
| | - Peter Hart
- Division of Nephrology, Cook County Health, 1950 W. Polk Street, 5th Floor, Chicago, IL, 60605, USA
| |
Collapse
|
10
|
Rauch A, Susen S, Zieger B. Acquired von Willebrand Syndrome in Patients With Ventricular Assist Device. Front Med (Lausanne) 2019; 6:7. [PMID: 30805339 PMCID: PMC6371037 DOI: 10.3389/fmed.2019.00007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/11/2019] [Indexed: 01/27/2023] Open
Abstract
During the last decade the use of ventricular assist devices (VADs) for patients with severe heart failure has increased tremendously. However, flow disturbances, mainly high shear induced by the device is associated with bleeding complications. Shear stress-induced changes in VWF conformation are associated with a loss of high molecular weight multimers (HMW) of VWF and an increased risk of bleeding. This phenomenon and its cause will be elaborated and reviewed in the following.
Collapse
Affiliation(s)
- Antoine Rauch
- INSERM, U1011, Univ. Lille, U1011-EGID, Institut Pasteur de Lille, Lille, France.,CHU Lille, Hematology and Transfusion, Lille, France
| | - Sophie Susen
- INSERM, U1011, Univ. Lille, U1011-EGID, Institut Pasteur de Lille, Lille, France.,CHU Lille, Hematology and Transfusion, Lille, France
| | - Barbara Zieger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| |
Collapse
|
11
|
|
12
|
The primary haemostasis is more preserved in thrombocytopenic patients with liver cirrhosis than cancer. Blood Coagul Fibrinolysis 2018; 29:307-313. [PMID: 29561276 DOI: 10.1097/mbc.0000000000000725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
: In thrombocytopenia, differences in haemostatic capacity may explain discrepancies in bleeding risk between patients with cancer and patients with liver cirrhosis. The objective was to compare the haemostatic capacity in different thrombocytopenic patient populations. We evaluated platelet aggregation using impedance aggregometry (Multiplate Analyzer), von Willebrand factor antigen (VWF:Ag), VWF:ristocetin-cofactor activity (VWF:RCo), activated partial thromboplastin time (aPTT), coagulation factor VIII, fibrinogen, and thrombin generation in adult hospitalized patients with platelet count less than 80 × 10/l. Patients either had liver cirrhosis (n = 28), or cancer (n = 169; n = 49 had haematological cancer) with no difference among patients with liver cirrhosis and cancer. Median platelet count was 48 × 10/l [interquartile range (IQR) 32-63 × 10/l]. Median platelet aggregation was higher in patients with cirrhosis than cancer, 416 AU × min (IQR 257-676) versus 145 AU × min (IQR 50-326) for collagen-induced platelet aggregation, P < 0.001. There was no difference in activated partial thromboplastin time (aPTT), coagulation factor VIII, or thrombin generation between the patient groups. Fibrinogen activity was higher in patients with cancer compared with patients with cirrhosis [12.5 μmol/L (IQR 9.9-16.5) versus 7.2 μmol/l (IQR 5.6-10.2)], P < 0.003. Patients with liver cirrhosis had a more preserved primary haemostasis compared with patients with cancer.
Collapse
|
13
|
Valbonesi M, Ferrari M, Zia S, Fella M, Malfanti L, Lamparelli E. Intraoperative Blood Salvage: A new Trend in Blood Transfusion Medicine. Int J Artif Organs 2018. [DOI: 10.1177/039139889001300102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M. Valbonesi
- Immunohematology Services, San Martino Hospital, Genoa
| | - M. Ferrari
- Immunohematology Services, San Martino Hospital, Genoa
| | - S. Zia
- Immunohematology Services, San Martino Hospital, Genoa
| | - M. Fella
- Immunohematology Services, San Martino Hospital, Genoa
| | - L. Malfanti
- Immunohematology Services, San Martino Hospital, Genoa
| | | |
Collapse
|
14
|
Franquiz MJ, Hines MC, Yeung SYA. Comparison of Two Weight-Based Desmopressin Dosing Strategies for Spontaneous Bleeding. Ann Pharmacother 2018; 52:527-532. [PMID: 29332421 DOI: 10.1177/1060028017752354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The pharmacokinetics and pharmacodynamics of desmopressin are appropriate for adjusted body weight-based dosing, particularly in obese patients. OBJECTIVE The objective of this study was to describe desmopressin dosing strategies, with emphasis on hemostatic outcomes among patients without preexisting bleeding disorders. METHODS This was a single-center, retrospective cohort study of patients who received intravenous weight-based desmopressin for a hemostatic indication. Demographics, comorbidities, treatment setting, indication, site of bleeding, and outcomes were collected from the medical record. Primary outcomes included need for procedural intervention to achieve hemostasis, transfusion requirement, and death. Association between desmopressin dose and outcome was evaluated using χ2 or Fischer's exact tests and logistic and linear regression models. Multiple regression analysis was conducted to identify other predictors of outcome in the data set. RESULTS A total of 109 patients were included (n = 26, dose adjustment; n = 83, no dose adjustment). Baseline characteristics were well-matched between groups: mean (SD) age of 57.0 (13.5) years; mean (SD) Charlson Comorbidity Score of 6.5 (2.8); 37% were obese; 76% were critically ill; 81% were actively bleeding without differences in site of bleeding; and crude mortality was 39%. No differences in death, mean units of packed red blood cells transfused, or need for procedural hemostasis were observed between adjusted weight- and actual weight-based desmopressin dosing. CONCLUSIONS When used adjunctively to blood product transfusion in actively bleeding patients, use of adjusted body weight-based desmopressin did not negatively affect clinical outcomes. More data are needed to confirm this dosing strategy.
Collapse
|
15
|
Jalaer I, Tsakiris D, Solecka-Witulska B, Kannicht C. The role of von Willebrand factor in primary haemostasis under conditions of haemodilution. Thromb Res 2017; 157:142-146. [DOI: 10.1016/j.thromres.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/24/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
|
16
|
Desborough MJ, Oakland K, Brierley C, Bennett S, Doree C, Trivella M, Hopewell S, Stanworth SJ, Estcourt LJ. Desmopressin use for minimising perioperative blood transfusion. Cochrane Database Syst Rev 2017; 7:CD001884. [PMID: 28691229 PMCID: PMC5546394 DOI: 10.1002/14651858.cd001884.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. OBJECTIVES To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders. SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (2017, issue 3) in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the Transfusion Evidence Library (from 1980), and ongoing trial databases (all searches to 3 April 2017). SELECTION CRITERIA We included randomised controlled trials comparing DDAVP to placebo or an active comparator (e.g. tranexamic acid, aprotinin) before, during, or immediately after surgery or after invasive procedures in adults or children. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We identified 65 completed trials (3874 participants) and four ongoing trials. Of the 65 completed trials, 39 focused on adult cardiac surgery, three on paediatric cardiac surgery, 12 on orthopaedic surgery, two on plastic surgery, and two on vascular surgery; seven studies were conducted in surgery for other conditions. These trials were conducted between 1986 and 2016, and 11 were funded by pharmaceutical companies or by a party with a commercial interest in the outcome of the trial.The GRADE quality of evidence was very low to moderate across all outcomes. No trial reported quality of life. DDAVP versus placebo or no treatmentTrial results showed considerable heterogeneity between surgical settings for total volume of red cells transfused (low-quality evidence) and for total blood loss (very low-quality evidence) due to large differences in baseline blood loss. Consequently, these outcomes were not pooled and were reported in subgroups.Compared with placebo, DDAVP may slightly decrease the total volume of red cells transfused in adult cardiac surgery (mean difference (MD) -0.52 units, 95% confidence interval (CI) -0.96 to -0.08 units; 14 trials, 957 participants), but may lead to little or no difference in orthopaedic surgery (MD -0.02, 95% CI -0.67 to 0.64 units; 6 trials, 303 participants), vascular surgery (MD 0.06, 95% CI -0.60 to 0.73 units; 2 trials, 135 participants), or hepatic surgery (MD -0.47, 95% CI -1.27 to 0.33 units; 1 trial, 59 participants).DDAVP probably leads to little or no difference in the total number of participants transfused with blood (risk ratio (RR) 0.96, 95% CI 0.86 to 1.06; 25 trials; 1806 participants) (moderate-quality evidence).Whether DDAVP decreases total blood loss in adult cardiac surgery (MD -135.24 mL, 95% CI -210.80 mL to -59.68 mL; 22 trials, 1358 participants), orthopaedic surgery (MD -285.76 mL, 95% CI -514.99 mL to -56.53 mL; 5 trials, 241 participants), or vascular surgery (MD -582.00 mL, 95% CI -1264.07 mL to 100.07 mL; 1 trial, 44 participants) is uncertain because the quality of evidence is very low.DDAVP probably leads to little or no difference in all-cause mortality (Peto odds ratio (pOR) 1.09, 95% CI 0.51 to 2.34; 22 trials, 1631 participants) or in thrombotic events (pOR 1.36, 95% CI, 0.85 to 2.16; 29 trials, 1984 participants) (both low-quality evidence). DDAVP versus placebo or no treatment for people with platelet dysfunctionCompared with placebo, DDAVP may lead to a reduction in the total volume of red cells transfused (MD -0.65 units, 95% CI -1.16 to -0.13 units; 6 trials, 388 participants) (low-quality evidence) and in total blood loss (MD -253.93 mL, 95% CI -408.01 mL to -99.85 mL; 7 trials, 422 participants) (low-quality evidence).DDAVP probably leads to little or no difference in the total number of participants receiving a red cell transfusion (RR 0.83, 95% CI 0.66 to 1.04; 5 trials, 258 participants) (moderate-quality evidence).Whether DDAVP leads to a difference in all-cause mortality (pOR 0.72, 95% CI 0.12 to 4.22; 7 trials; 422 participants) or in thrombotic events (pOR 1.58, 95% CI 0.60 to 4.17; 7 trials, 422 participants) is uncertain because the quality of evidence is very low. DDAVP versus tranexamic acidCompared with tranexamic acid, DDAVP may increase the volume of blood transfused (MD 0.6 units, 95% CI 0.09 to 1.11 units; 1 trial, 40 participants) and total blood loss (MD 142.81 mL, 95% CI 79.78 mL to 205.84 mL; 2 trials, 115 participants) (both low-quality evidence).Whether DDAVP increases or decreases the total number of participants transfused with blood is uncertain because the quality of evidence is very low (RR 2.42, 95% CI 1.04 to 5.64; 3 trials, 135 participants).No trial reported all-cause mortality.Whether DDAVP leads to a difference in thrombotic events is uncertain because the quality of evidence is very low (pOR 2.92, 95% CI 0.32 to 26.83; 2 trials, 115 participants). DDAVP versus aprotininCompared with aprotinin, DDAVP probably increases the total number of participants transfused with blood (RR 2.41, 95% CI 1.45 to 4.02; 1 trial, 99 participants) (moderate-quality evidence).No trials reported volume of blood transfused or total blood loss and the single trial that included mortality as an outcome reported no deaths.Whether DDAVP leads to a difference in thrombotic events is uncertain because the quality of evidence is very low (pOR 0.98, 95% CI 0.06 to 15.89; 2 trials, 152 participants). AUTHORS' CONCLUSIONS Most of the evidence derived by comparing DDAVP versus placebo was obtained in cardiac surgery, where DDAVP was administered after cardiopulmonary bypass. In adults undergoing cardiac surgery, the reduction in volume of red cells transfused and total blood loss was small and was unlikely to be clinically important. It is less clear whether DDAVP may be of benefit for children and for those undergoing non-cardiac surgery. A key area for researchers is examining the effects of DDAVP for people with platelet dysfunction. Few trials have compared DDAVP versus tranexamic acid or aprotinin; consequently, we are uncertain of the relative efficacy of these interventions.
Collapse
Affiliation(s)
| | - Kathryn Oakland
- NHS Blood and TransplantHaematology/Transfusion MedicineOxfordUK
| | - Charlotte Brierley
- John Radcliffe HospitalDepartment of HaematologyHeadley WayOxfordUKOX3 9DU
| | - Sean Bennett
- University of OttawaDepartment of Surgery501 Smyth RoadOttawaOntarioCanadaK1M 1R4
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordOxfordshireUKOX3 7LD
| | - Simon J Stanworth
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNational Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe Hospital, Headley WayHeadingtonOxfordUKOX3 9BQ
| | - Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineOxfordUK
| | | |
Collapse
|
17
|
Orlov D, McCluskey SA, Callum J, Rao V, Moreno J, Karkouti K. Utilization and Effectiveness of Desmopressin Acetate After Cardiac Surgery Supplemented With Point-of-Care Hemostatic Testing: A Propensity-Score–Matched Analysis. J Cardiothorac Vasc Anesth 2017; 31:883-895. [DOI: 10.1053/j.jvca.2016.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Indexed: 01/09/2023]
|
18
|
Jahangirifard A, Razavi MR, Ahmadi ZH, Forozeshfard M. Effect of Desmopressin on the Amount of Bleeding and Transfusion Requirements in Patients Undergoing Heart Transplant Surgery. Basic Clin Pharmacol Toxicol 2017; 121:175-180. [PMID: 28326680 DOI: 10.1111/bcpt.12780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/15/2017] [Indexed: 11/29/2022]
Abstract
One of the most common risks after a heart transplant is bleeding. In this study, the effect of desmopressin administration on the amount of bleeding and transfusion requirements after heart transplant surgery was investigated. In a double-blind clinical trial, 48 patients who were candidates for heart transplant surgery were randomly assigned to two groups. In the intervention group, patients received desmopressin of 0.3 μg/kg, 30 min. before surgery. Patients in the control group received normal saline at the same amount and time. Homeostasis was evaluated using activated clotting time (ACT), PT, PTT and PLT before, 12 and 24 hr after surgery, and also, chest tube drainage, blood products transfusion requirements during the first day in both groups. No significant differences were found between the groups in terms of ACT, PT, PTT and PLT at all times. Transfusion of packed red blood cells and the mean drainages of chest tube during the first 24 hr after surgery were significantly lower in the desmopressin group compared to the saline group. Desmopressin may reduce post-operative bleeding in patients undergoing heart transplant surgery. Further studies are required to confirm the potential effect of desmopressin on establishing haemostasis after heart transplantation.
Collapse
Affiliation(s)
- Alireza Jahangirifard
- Cardiac Anesthesiology, Tracheal Diseases Research Center, NRITLD, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Razavi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Zargham Hosein Ahmadi
- Department of Surgery, Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Forozeshfard
- Cancer Research Center and Department of Anesthesiology, Semnan University of Medical Sciences, Semnan, Iran
| |
Collapse
|
19
|
Primavessy D, Günday Türeli N, Schneider M. Influence of different stabilizers on the encapsulation of desmopressin acetate into PLGA nanoparticles. Eur J Pharm Biopharm 2016; 118:48-55. [PMID: 28011093 DOI: 10.1016/j.ejpb.2016.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/18/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022]
Abstract
To address targeting and bioavailability issues of peptidic drugs like desmopressin, the encapsulation into nanoparticles (NP) has become standard in pharmaceutics. This study investigated the encapsulation of desmopressin into PLGA NP by the use of pharmaceutically common stabilizers as a precursor to future, optional targeting and bioavailability experiments. Polymer dry weights were measured by freeze drying and thermo gravimetric analysis (TGA). Particle sizes (ranging between 105 and 130nm, PDI<0.1) and zeta potentials (-35 to -45mV) were analyzed with Dynamic Light Scattering (DLS) and Laser-Doppler-Anemometry (LDA) respectively. Highest loading efficiencies, quantified by RP-HPLC, were achieved with Pluronic F-68 as stabilizer of the inner aqueous phase (1.16±0.07μg desmopressin/mg PLGA) and were significantly higher than coating approaches and approaches without stabilizer (0.74±0.01μg/mg). Optimized nanoformulations are thus in competition with the concentration of commercial non-nanoparticulate desmopressin products. Stability of desmopressin after the process was evaluated by HPLC peak purity analysis (diode array detector) and by mass spectrometry. Desmopressin was shown to remain intact during the whole process; however, despite these very good results the encapsulation efficiency turned out to be a bottle neck and makes the system a challenge for potential applications.
Collapse
Affiliation(s)
- Daniel Primavessy
- Department of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, Campus A4 1, Saarland University, D-66123 Saarbrücken, Germany; Department of Pharmaceutics and Biopharmacy, Philipps University Marburg, D-35032 Marburg, Germany
| | - Nazende Günday Türeli
- Department of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, Campus A4 1, Saarland University, D-66123 Saarbrücken, Germany; MJR PharmJet GmbH, Industriestr. 1B, 66802 Überherrn, Germany
| | - Marc Schneider
- Department of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, Campus A4 1, Saarland University, D-66123 Saarbrücken, Germany.
| |
Collapse
|
20
|
Abstract
Despite refinements in cardiac surgical technique, disorders of haemostasis remain a significant problem, reflecting the effects of cardiopulmonary bypass on blood cell activation and coagulation. Increased understanding of the dangers of blood and blood product transfusion have shifted the goals from blood replacement to blood conservation in cardiac surgery. Two approaches to blood conservation are used: autotransfusion and administration of pharmacological agents. These approaches may be complementary, but the latter approach- preventing or at least modifying the haemostatic disorder- may be preferable. This paper reviews some of the pharmacological agents that have been used in an attempt to conserve blood, including e-aminocaproic acid, desmopressin, prostacyclin, tranexamic acid, dipyridamole, and aprotinin. None of these agents has been able to eliminate the need for blood transfusion in all patients; aprotinin has been successful, however, in eliminating the need for transfusion in some patients and dramatically reducing the need in others.
Collapse
|
21
|
Abstract
Preliminary findings of a prospective, randomized, double-blind study of aprotinin in patients undergoing repeat myocardial revascularization procedures are presented. Use of high- or low-dose aprotinin led to signfiicant (p < 0.001) reductions in postoperative chest tube drainage compared with placebo (720 ± 753 ml, 866 ± 1636 ml, and 1121 ± 683 ml, respectively). Aprotinin also yielded significant reductions in transfusion requirements (2.1 ± 4.2 units, 4.8 ± 11.8 units, and 4.1 ± 6.2 units). These reductions were similar in a subgroup of patients who received aspirin preoperatively. In both aprotinin groups, there was a non-significant trend toward increased risk of Q-wave myocardial infarction. In six of 12 vein grafts studied at post-mortem examination from aprotinin-treated patients, acute vein graft thrombosis was found. This was not seen in any of five grafts from placebo-treated patients. In conclusion, aprotinin significantly reduces bleeding and transfusion requirements in patients undergoing repeat myocardial revascularization. The non-significantly increased risk of graft thrombosis requires further study.
Collapse
Affiliation(s)
- Delos M Cosgrove
- Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
22
|
Transfusion Therapy in Specific Clinical Situations. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
23
|
Bignami E, Cattaneo M, Crescenzi G, Ranucci M, Guarracino F, Cariello C, Baldassarri R, Isgrò G, Baryshnikova E, Fano G, Franco A, Gerli C, Crivellari M, Zangrillo A, Landoni G. Desmopressin after cardiac surgery in bleeding patients. A multicenter randomized trial. Acta Anaesthesiol Scand 2016; 60:892-900. [PMID: 27117753 DOI: 10.1111/aas.12740] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies showed that desmopressin decreases post-operative blood loss in patients undergoing cardiac surgery. These studies were small and never studied the effect of desmopressin in patients with active bleeding. Objective of the study was to determine whether desmopressin reduces red blood cells transfusion requirements in patients with active bleeding after cardiac surgery who had been pre-treated with tranexamic acid. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group study randomized elective patients with bleeding after cardiac surgery despite pre-treatment with tranexamic acid, to receive placebo (saline solution) or a single administration of desmopressin (0.3 μg/kg in saline solution). The primary endpoint was the number of patients requiring red blood cells transfusion after randomization and during hospital stay. Secondary end points were: blood loss from chest tubes during the first 24 h after study drug administration, hours of mechanical ventilation, intensive care unit stay, and in-hospital mortality. RESULTS The study was interrupted after inclusion of 67% of the planned patients for futility. The number of patients requiring red blood cells transfusion after randomization was 37/68 (54%) in desmopressin group and 33/67 (49%) in placebo group (P = 0.34) with no difference in blood loss: 575 (interquartile 422-770) ml in desmopressin group and 590 (476-1013) ml in placebo group (P = 0.42), mechanical ventilation, intensive care unit stay or mortality. CONCLUSIONS This multicenter randomized trial demonstrated that, in patients pre-treated with tranexamic acid, desmopressin should not be expected to improve treatment of patients who experience bleeding after cardiac surgery.
Collapse
Affiliation(s)
- E. Bignami
- Department of Anesthesia and Intensive Care; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Cattaneo
- ASST Santi Paolo e Carlo; Dipartimento di Scienze della Salute; Università degli Studi di Milano
| | - G. Crescenzi
- Department of Anesthesia and Intensive Care; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care; IRCCS Policlinico San Donato; Milan Italy
| | - F. Guarracino
- Department of Anesthesia and Intensive Care; University Hospital of Pisa; Pisa Italy
| | - C. Cariello
- Department of Anesthesia and Intensive Care; University Hospital of Pisa; Pisa Italy
| | - R. Baldassarri
- Department of Anesthesia and Intensive Care; University Hospital of Pisa; Pisa Italy
| | - G. Isgrò
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care; IRCCS Policlinico San Donato; Milan Italy
| | - E. Baryshnikova
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care; IRCCS Policlinico San Donato; Milan Italy
| | - G. Fano
- Department of Anesthesia and Intensive Care; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - A. Franco
- Department of Anesthesia and Intensive Care; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - C. Gerli
- Department of Anesthesia and Intensive Care; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Crivellari
- Department of Anesthesia and Intensive Care; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - A. Zangrillo
- Department of Anesthesia and Intensive Care; IRCCS San Raffaele Scientific Institute; Milan Italy
- Vita-Salute San Raffaele University; Milan Italy
| | - G. Landoni
- Department of Anesthesia and Intensive Care; IRCCS San Raffaele Scientific Institute; Milan Italy
- Vita-Salute San Raffaele University; Milan Italy
| |
Collapse
|
24
|
Skubas NJ, Despotis GJ. Optimal Management of Bleeding Complications After Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/scva.2001.26127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients undergoing cardiac surgery with cardiopulmo nary bypass (CPB) are at increased risk for excessive perioperative blood loss requiring transfusion of blood products. Point-of-care evaluation of platelets, coagu lation factors, and fibrinogen can enable physicians to assess bleeding abnormalities rapidly. They also can facilitate the optimal administration of pharmacologic and transfusion-based therapy and allow physicians to identify patients with surgical bleeding. The ability to reduce the unnecessary use of blood products in this setting has important implications for emerging issues in blood inventory and blood costs. The ability to de crease operative time along with re-exploration rates has important consequences for health care costs in an increasingly managed health care environment. Copyright© 2001 by W.B. Saunders Company.
Collapse
Affiliation(s)
- Nikolaos J. Skubas
- Departments of Anesthesiology, Pathology, and Immunology, Washington University School of Medicine, St. Louis, MO
| | - George J. Despotis
- Departments of Anesthesiology, Pathology, and Immunology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
25
|
Mirmansoori A, Farzi F, Sedighinejad A, Imantalab V, mohammadzadeh A, Atrkar Roushan Z, Ghazanfar Tehran S, Nemati M, Dehghan A. The Effect of Desmopressin on the Amount of Bleeding in Patients Undergoing Coronary Artery Bypass Graft Surgery with a Cardiopulmonary Bypass Pump After Taking Anti-Platelet Medicine. Anesth Pain Med 2016; 6:e39226. [PMID: 27847701 PMCID: PMC5101425 DOI: 10.5812/aapm.39226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/05/2016] [Accepted: 06/22/2016] [Indexed: 02/03/2023] Open
Abstract
Background Coronary artery bypass grafting (CABG) is a common surgical intervention at the end-stages of coronary artery occlusion disease. Despite the effectiveness of CABG, it may have particular complications, such as bleeding during and after surgery. So far, there have been many drugs used to reduce bleeding. Objectives This study aimed at investigating the effects of desmopressin on the amount of bleeding in patients undergoing CABG with a cardiopulmonary bypass pump (CPBP) who were taking anti-platelet medicine. Methods One hundred patients scheduled for elective CABG with a CPBP were included in a prospective, placebo-controlled, double-blinded clinical trial study. They were randomly divided into two groups. One group received desmopressin (40 μg) and the other group received a placebo (isotonic saline). Seven patients were excluded from the study, and 47 and 46 patients participated in the desmopressin and control groups, respectively. The methods of monitoring and the anesthetic techniques were similar in both groups, and all surgeries were performed by one surgeon. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (e.g., nausea and vomiting, blood pressure changes), the necessity to receive blood products, and coagulation tests (prothrombin time, partial thromboplastin time, international normalized ratio, and bleeding time) were assessed. Data were statistically analyzed with SPSS software version 17. Results There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complications, and the changes in hemoglobin and coagulation test measurements (P > 0.05). No significant difference was noted between the groups regarding the rate of bleeding after surgery (359.3 ± 266.2 in group D vs. 406.3 ± 341.6 in group P (control group); P = 0.208). However, the platelet changes after surgery in both groups were significantly different. The analysis revealed that the rate of thrombocytopenia after surgery was higher in the control group (P = 0.012). Conclusions Our study showed that desmopressin could not reduce the amount of blood loss after CABG. Also, desmopressin did not have a significant effect on coagulation status. Therefore, based on the results of our study, it seems that the use of this medication cannot be a helpful for patients with any indication for CABG.
Collapse
Affiliation(s)
- Ali Mirmansoori
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Farnoush Farzi, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9113311653, Fax: +98-1333369024, E-mail:
| | - Abbas Sedighinejad
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Vali Imantalab
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali mohammadzadeh
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | | | - Maryam Nemati
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Afsaneh Dehghan
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
26
|
|
27
|
Abstract
Desmopressin is a widely used haemostatic drug. In contrast to vasopressin, it has no pressor activity. The effect is immediate, with two to six-fold increases in the plasma concentrations of coagulation factor VIII, von Willebrand factor and tissue plasminogen activator, and of platelet adhesiveness. Desmopressin is used in patients with mild haemophilia A, von Willebrand's disease, congenital platelet dysfunction or acquired platelet dysfunction due to uraemia or such drugs as aspirin. Tranexamic acid is an antifibrinolytic agent effective against menorrhagia, epistaxis and bleeding after conization or oral surgery; its haemostatic effect in connection with major surgery is presently being evaluated.
Collapse
Affiliation(s)
- Stefan Lethagen
- Department for Coagulation Disorders, University of Lund, Malmö General Hospital, Malmö
| |
Collapse
|
28
|
Kickler T. How Safe Are Transfusions? Measures to Increase Safety. J Intensive Care Med 2016. [DOI: 10.1177/088506668900400301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Thomas Kickler
- Department of Laboratory Medicine The Johns Hopkins Hospital 600 North Wolfe St Baltimore, MD 21205
| |
Collapse
|
29
|
|
30
|
López-López J, Jané-Salas E, Santamaría A, González-Navarro B, Arranz-Obispo C, López R, Miquel I, Arias B, Sánchez P, Rincón E, Rodríguez JR, Rojas S, Murat J. TETIS study: evaluation of new topical hemostatic agent TT-173 in tooth extraction. Clin Oral Investig 2015; 20:1055-63. [PMID: 26374745 DOI: 10.1007/s00784-015-1586-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 08/30/2015] [Indexed: 01/14/2023]
Affiliation(s)
- José López-López
- Department of Odontostomatology, School of Dentistry-Hospital Odontológico Universidad de Barcelona, Barcelona University, C/Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain.
| | - Enric Jané-Salas
- Department of Odontostomatology, School of Dentistry-Hospital Odontológico Universidad de Barcelona, Barcelona University, C/Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Amparo Santamaría
- Hemostasia and Thrombosis Unit, Department of Hematology, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Beatriz González-Navarro
- Department of Odontostomatology, School of Dentistry-Hospital Odontológico Universidad de Barcelona, Barcelona University, C/Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlos Arranz-Obispo
- Department of Odontostomatology, School of Dentistry-Hospital Odontológico Universidad de Barcelona, Barcelona University, C/Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón López
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Ignasi Miquel
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Belén Arias
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Pilar Sánchez
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Esther Rincón
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Juan R Rodríguez
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Santiago Rojas
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| | - Jesus Murat
- S.L. Parque Mediterráneo de la Tecnología, Thombotargets Europe, Castelldefels, Spain
| |
Collapse
|
31
|
Besser MW, Ortmann E, Klein AA. Haemostatic management of cardiac surgical haemorrhage. Anaesthesia 2014; 70 Suppl 1:87-95, e29-31. [DOI: 10.1111/anae.12898] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. W. Besser
- Department of Haematology; Papworth Hospital; Cambridge UK
| | - E. Ortmann
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
- Department of Anaesthesia and Intensive Care; Kerckhoff Klinik Heart and Lung Centre; Bad Nauheim Germany
| | - A. A. Klein
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
| |
Collapse
|
32
|
O'Sullivan KE, Kelly JC, Hurley JP. The 100 most cited publications in cardiac surgery: a bibliometric analysis. Ir J Med Sci 2014; 184:91-9. [PMID: 25208821 DOI: 10.1007/s11845-014-1193-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/02/2014] [Indexed: 01/04/2023]
Abstract
INTRODUCTION This study is a citation analysis of the top 100 most cited papers in adult cardiac surgery. Bibliometric analyses are viewed as a proxy marker of a paper's influence and, therefore, an analysis of the most influential papers published in recent decades. METHODS Impact factor ranking as of 2012 was used to decide which journals to include in our searches. The Thompson Reuters Web of Knowledge was used to search for citations of all papers relevant to cardiac surgery within selected journals. Journals in the areas of surgery, cardiothoracic surgery, general medicine, anaesthesia, perfusion and pathology were included. RESULTS The most frequently cited paper was found to be that of Nashef et al. (Eur J Cardiothorac Surg 16(1):9-13, 1999) introducing the EuroSCORE operative risk evaluation system. A number of authors including Alderman, Carpentier and Cox had more than one paper in the top 100. CONCLUSION Despite the potential flaws with bibliometric analysis, and its application to cardiac surgery, there is inherent merit in an analysis of this type.
Collapse
Affiliation(s)
- K E O'Sullivan
- Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland,
| | | | | |
Collapse
|
33
|
|
34
|
Wademan BH, Galvin SD. Desmopressin for reducing postoperative blood loss and transfusion requirements following cardiac surgery in adults. Interact Cardiovasc Thorac Surg 2013; 18:360-70. [PMID: 24263581 DOI: 10.1093/icvts/ivt491] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in adult patients undergoing cardiac surgery requiring extracorporeal cardiopulmonary bypass (CPB), does administration of desmopressin acetate (DDAVP) reduce postoperative blood loss and transfusion requirements? Altogether 38 papers were found using the reported search, of which 19 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Perioperative administration of DDAVP in adult patients undergoing cardiac surgery requiring CPB may result in a small but significant reduction in postoperative blood loss. However, this does not translate into a reproducible, clinically significant reduction in exposure to transfusion in unselected patients exposed to CPB. Several sub-groups of patients have been identified in whom DDAVP reduces postoperative blood loss and transfusion requirements. These sub-groups include patients who have received preoperative aspirin within 7 days of surgery, patients with CPB times in excess of 140 min and patients with demonstrable pre- or perioperative platelet dysfunction as determined by TEG analysis or platelet function assays. Platelet dysfunction at the time of surgery may be secondary to preoperative administration of antiplatelet medications, the result of pathological processes such as von Willebrands disease, uraemia or aortic stenosis with its associated sheer stress, as well as operative variables such as prolonged exposure to CPB. The evidence does not support the routine use of DDAVP in all cardiac surgery; indeed, it is clear that there is no significant reduction in postoperative blood loss or transfusion requirements with the administration of DDAVP in patients undergoing isolated coronary artery bypass grafting (CABG) in the absence of the features noted above. Given the absence of a clinically significant reduction in exposure to blood transfusion in unselected patients, we cannot recommend the routine use of DDAVP in patients exposed to CPB. However, DDAVP may reduce postoperative bleeding in patients who have received preoperative aspirin within 7 days of surgery, patients with CPB times in excess of 140 min and patients with demonstrable platelet dysfunction and should be used selectively in these subgroups.
Collapse
Affiliation(s)
- Brecon H Wademan
- Department of Cardiothoracic Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | | |
Collapse
|
35
|
Matsushita T, Masuda S, Hayashida K, Usui K. A novel chest packing technique for intractable bleeding after open heart surgical procedures. Ann Thorac Surg 2013; 96:1099-101. [PMID: 23992718 DOI: 10.1016/j.athoracsur.2013.04.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/02/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
Intractable bleeding after cardiac surgical procedures is a life-threatening complication. In most cases, the main bleeding site is present in the retrosternal space, not the pericardial space. Packing the chest may be a useful technique for achieving hemostasis. Herein, we describe a novel and effective procedure for the treatment of intractable bleeding in the retrosternal space using a sheet of oxidized regenerated cellulose and sponges after cardiac surgical procedures.
Collapse
Affiliation(s)
- Tsutomu Matsushita
- Department of Cardiovascular Surgery, Maizuru Mutual Hospital, Kyoto, Japan.
| | | | | | | |
Collapse
|
36
|
Mannucci PM, Cattaneo M. Desmopressin (DDAVP). Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
37
|
Affiliation(s)
- Joseph Loscalzo
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| |
Collapse
|
38
|
Lusher JM. Pharmacology and Pharmacokinetics of Desmopressin in Haemostatic Disorders. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/bf03258240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
|
40
|
|
41
|
Transfusion Therapy in Specific Clinical Situations. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
42
|
Panico ML, Jenq GY, Brewster UC. When a patient refuses life-saving care: issues raised when treating a Jehovah's Witness. Am J Kidney Dis 2011; 58:647-53. [PMID: 21862193 DOI: 10.1053/j.ajkd.2011.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 05/01/2011] [Indexed: 12/26/2022]
Abstract
Patients who are Jehovah's Witnesses frequently cross the path of nephrologists when they are acutely ill in the intensive care unit and stable in the long-term setting. It is important that we as a group have a rudimentary understanding of their philosophy about blood transfusion so that we can be proactive in their management. We use a case as a launching point to discuss the origins of the faith and the decision to refuse blood, as well as potential therapeutic strategies that can be used to improve the care of these patients. Improvement in our understanding as physicians will facilitate a more productive conversation with our patients about a complex and emotional issue.
Collapse
Affiliation(s)
- Megan L Panico
- Yale Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8029, USA
| | | | | |
Collapse
|
43
|
|
44
|
Ranucci M, Aronson S, Dietrich W, Dyke CM, Hofmann A, Karkouti K, Levi M, Murphy GJ, Sellke FW, Shore-Lesserson L, von Heymann C. Patient blood management during cardiac surgery: Do we have enough evidence for clinical practice? J Thorac Cardiovasc Surg 2011; 142:249.e1-32. [DOI: 10.1016/j.jtcvs.2011.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 02/09/2011] [Accepted: 04/08/2011] [Indexed: 12/13/2022]
|
45
|
Whittier WL. Percutaneous Kidney Biopsy: “The Needle and the Damage Done”? Am J Kidney Dis 2011; 57:808-10. [DOI: 10.1053/j.ajkd.2011.02.375] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 02/22/2011] [Indexed: 11/11/2022]
|
46
|
Steinlechner B, Zeidler P, Base E, Birkenberg B, Ankersmit HJ, Spannagl M, Quehenberger P, Hiesmayr M, Jilma B. Patients with severe aortic valve stenosis and impaired platelet function benefit from preoperative desmopressin infusion. Ann Thorac Surg 2011; 91:1420-6. [PMID: 21439546 DOI: 10.1016/j.athoracsur.2011.01.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/14/2011] [Accepted: 01/20/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with severe aortic valve stenosis have a markedly reduced platelet function as measured by a prolonged collagen adenosine diphosphate closure time (CADP-CT) determined by the platelet function analyzer PFA-100. We hypothesized that such patients may benefit from desmopressin when they present with prolonged CADP-CT due to the specific action of desmopressin on von Willebrand factor (VWF) and CADP-CT. METHODS In this double-blind, randomized placebo controlled trial, 43 patients undergoing aortic valve replacement (due to severe aortic valve stenosis with CADP-CT>170 seconds) were given desmopressin 0.3 μg/kg or saline intravenously after induction of anesthesia. Measurement of CADP-CT, factor VIII activity, von Willebrand factor antigen, GpIb binding activity, ristocetin cofactor activity, collagen-binding activity, and multimers were performed after induction of anesthesia, one hour after desmopressin infusion, and 24 hours postoperatively. RESULTS In the majority of patients, baseline values of von Willebrand factor related indices were normal, but increased one hour after infusion of desmopressin by 73% to 90% as compared with placebo. Selective loss of high molecular weight multimers was seen only in a minority of patients. The CADP-CT was greater than 170 seconds in 92% of screened patients, and desmopressin shortened CADP-CT by 48% versus baseline and reduced postoperative blood loss by 42% (p<0.001). CONCLUSIONS Prolonged CADP-CT indicates platelet dysfunction in severe aortic valve stenosis, and can guide the use of desmopressin as an effective prohemostatic agent in patients with severe aortic valve stenosis.
Collapse
Affiliation(s)
- Barbara Steinlechner
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW Patients often receive preoperative therapies that interfere with hemostasis, and can present for surgery with underlying hemostatic disorders because of pre-existing preoperative anticoagulation or antiplatelet therapy. Perioperative bleeding can occur following surgery due to multiple causes; however, the addition of pharmacologic agents creates an acquired defect that complicates the surgical injury and may result in increased blood loss. An understanding of the potential impact of anticoagulation therapies on hemostasis is critical in managing these patients. Further, newer agents are evolving in clinical practice that clinicians should be aware of. RECENT FINDINGS The anticoagulants and antiplatelet agents that patients are receiving preoperatively apart from unfractionated heparin include low-molecular-weight heparins (LMWHs); a pentasaccharide (fondaparinux); oral anticoagulants: vitamin K antagonists (warfarin), new oral Xa inhibitors (rivaroxaban, apixiban), or the oral direct thrombin inhibitor (DTI) dabigatran; platelet inhibitors: thienopyridines (clopidogrel, ticlopidine, prasugrel) or IIb/IIIa receptor antagonists (tirofiban, abciximab, eptifibatide); or DTIs (r-hirudin, bivalirudin, argatroban). SUMMARY There are multiple pharmacologic therapies that surgical patients may be exposed to preoperatively, although there are currently few available methods to antagonize their effects. Often therapeutic prohemostatic pharmacologic approaches are used to treat or prevent bleeding, in addition to transfusional therapies.
Collapse
|
48
|
Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Stahel PF, Vincent JL, Spahn DR. Management of bleeding following major trauma: an updated European guideline. Crit Care 2010; 14:R52. [PMID: 20370902 PMCID: PMC2887168 DOI: 10.1186/cc8943] [Citation(s) in RCA: 468] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 03/23/2010] [Accepted: 04/06/2010] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. METHODS The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. RESULTS Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. CONCLUSIONS This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients.
Collapse
Affiliation(s)
- Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Bertil Bouillon
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Hospital Cologne Merheim, Ostmerheimerstrasse 200, 51109 Cologne, Germany
| | - Vladimir Cerny
- Faculty of Medicine in Hradec Králové, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic
| | - Timothy J Coats
- Accident and Emergency Department, University of Leicester, Infirmary Square, Leicester LE1 5WW, UK
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, University of Paris XI, Faculté de Médecine Paris-Sud, 63 rue Gabriel Péri, 94276 Le Kremlin-Bicêtre, France
| | - Enrique Fernández-Mondéjar
- Department of Emergency and Critical Care Medicine, University Hospital Virgen de las Nieves, ctra de Jaén s/n, 18013 Granada, Spain
| | - Beverley J Hunt
- Guy's & St Thomas' Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, 3000 Celje, Slovenia
| | - Giuseppe Nardi
- Shock and Trauma Center, S. Camillo Hospital, I-00152 Rome, Italy
| | - Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), Ostmerheimerstrasse 200, 51109 Cologne, Germany
| | - Yves Ozier
- Department of Anaesthesia and Intensive Care, Université Paris Descartes, AP-HP Hopital Cochin, Paris, France
| | - Louis Riddez
- Department of Surgery and Trauma, Karolinska University Hospital, 171 76 Solna, Sweden
| | - Arthur Schultz
- Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology and Lorenz Boehler Trauma Center, Donaueschingenstrasse 13, 1200 Vienna, Austria
| | - Philip F Stahel
- Department of Orthopaedic Surgery and Department of Neurosurgery, University of Colorado Denver School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Donat R Spahn
- Institute of Anesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
| |
Collapse
|
49
|
|
50
|
Favory R, Salgado DR, Vincent JL. Investigational vasopressin receptor modulators in the pipeline. Expert Opin Investig Drugs 2010; 18:1119-31. [PMID: 19589090 DOI: 10.1517/13543780903066764] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The vasopressin system is complex and interacts with the central nervous, cardiovascular, renal, and hematological systems. Vasopressin plays an important role in the control of blood osmolarity and vascular tone, but is also involved in many other physiological events, which are mediated mainly via three types of vasopressin receptor: V1R, V2R, and V3R. V1R primarily mediate the vascular, and V2R the aquaretic, effects of vasopressin. Vasopressin may also interact with other receptors, like adrenergic and angiotensin-II receptors, or with distinct biological pathways, including those of nitric oxide and the K(ATP) channel. There are numerous clinical situations where vasopressin receptor modulators (agonists or antagonists) could be used. Currently, vasopressin and terlipressin are most commonly used to stimulate V1R in vasodilatory shock and cardiac arrest, while desmopressin, a synthetic analogue of vasopressin, acts on V2R; but new molecules are becoming available in the treatment of inappropriate antidiuretic hormone (ADH) secretion.
Collapse
Affiliation(s)
- Raphaël Favory
- Université Libre de Bruxelles, Erasme Hospital, Department of Intensive Care, Brussels, Belgium
| | | | | |
Collapse
|