A Stratified Metaanalysis of Desmopressin (DDAVP) for Minimising Perioperative Allogeneic Blood Transfusion.

DDAVP has been evaluated in post-operative surgery patients without inherited bleeding disorders to determine whether it decreases blood loss and can minimise exposure to allogeneic transfusion. Previous reviews with overall negative results have not discriminated between prophylactic and therapeutic indications for DDAVP (Carless et al. 2006). The aim of this analysis was to create a systematic metaanalysis stratified for prophylactic administration of DDAVP to all patients as compared to a therapeutic indication, defined as blood loss >1l in the control group or prior aspirin medication.

Studies were evaluated in the metaanalysis when they were controlled 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.

Eighteen trials of DDAVP (n=1295) reported data on the number of patients transfused with allogeneic RBC transfusion. In subjects treated with DDAVP for therapeutic reasons, the pooled relative risk of exposure to perioperative allogeneic RBC transfusion was 0.36 (95%CI = 0.19 to 0.66). The use of DDAVP did significantly reduce blood loss; weighted mean difference (WMD) =-386 ml: 95% confidence interval (95%CI) =-542 to -231ml per patient) or the volume of RBC transfused (WMD = -340 ml: 95%CI = -547 to -134 ml per patient). In contrast, in subjects treated with DDAVP for prophylactic reasons, no significant benefit from using DDAVP was found.

Desmopressin administered for therapeutic indications significantly minimises perioperative allogeneic RBC transfusion in patients who do not have congenital bleeding disorders.

Zotz:CSL Behring: Research Funding. Off Label Use: DDAVP is a widely used drug for increasing coagulation factor VIII and von Willebrand Factor activities.