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Desmopressin before liver transplantation

Houston, Texas

To the Editor:

We read the well-conducted study by Wong et al.¹ with interest. They found that desmopressin in patients undergoing hepatectomy (including those with cirrhosis) increased factor VIII and von Willebrand factor levels, marginally shortened the partial thromboplastin time (PTT) and had no effect on blood loss. We too had anticipated a beneficial effect of desmopressin in surgical patients with cirrhosis based on results in the medical cirrhotic population^2,3 and in vitro results in patients undergoing liver transplantation (LT).⁴

After Institutional approval and patient consent, we administered desmopressin (0.3 µg•kg^-1) after anesthetic induction to nine patients undergoing LT. Baseline coagulation tests (prothrombin time, PTT, platelet count, thrombelastograph and Sonoclot analysis) were performed immediately prior to desmopressin and after 15 and 30 min. Data collection was completed before surgical incision and the possible confounding effects on coagulation.

Surprisingly, we found no short-term change in any of the measured variables (P > 0.2), including those that were abnormal at baseline. Although effects of desmopressin have been demonstrated within 30 min, this period may have been insufficient in our population, and there is data to suggest that a dose > 0.3 µg•kg^-1 may be more beneficial.² However, given these findings, we did not proceed with a prospective, randomized study.

Until Wong et al.’s study, there had been no systematic investigation of desmopressin in a surgical population with liver disease, and their data will be useful for clinicians who have had to rely on either in vitro data, data from non-surgical patients or preliminary studies such as ours.

References

1 Wong AYC, Irwin MG, Hui TWC, Fung SKY, Fan ST, Ma ESK. Desmopressin does not decrease blood loss and transfusion requirements in patients undergoing hepatectomy. Can J Anesth 2003; 50: 14–20.[Abstract/Free Full Text]

2 Agnelli G, Parise P, Levi M, Cosmi B, Nenci GG. Effects of desmopressin on hemostasis in patients with liver cirrhosis. Haemostasis 1995; 25: 241–7.[Medline]

3 Burroughs AK, Matthews K, Qadari M, et al. Desmopressin and bleeding time in patients with cirrhosis. Br Med J 1985; 291: 1377–81.

4 Kang Y, Scott V, DeWolf A, Roskoph J, Aggarwal S. In vitro effects of DDAVP during liver transplantation. Transplant Proc 1993; 25: 1821–2.[Medline]

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