Surgical Research Laboratory, University Medical Center Groningen, Groningen, The Netherlands.
Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Liver Int. 2015 Jul;35(7):1809-15. doi: 10.1111/liv.12765. Epub 2015 Jan 21.
BACKGROUND & AIMS: Cirrhosis frequently affects multiple components of hemostasis. Reversal of the coagulopathy of these patients is frequently required in case of bleeding episodes, or as prophylaxis before invasive procedures. Although 1-deamino-8-D-arginine vasopressin (DDAVP) is widely used as a pro-hemostatic agent in patients with cirrhosis, it is unclear whether DDAVP truly enhances hemostasis in these patients. Here we investigated the hemostatic effects of a single bolus of DDAVP in patients with cirrhosis.
Ten patients with cirrhosis (child B or C) and ten patients with mild haemophilia A received an intravenous single bolus of 0.3 microgram/kg DDAVP. Plasma was collected prior to and at 1, 3, 6, and 24 h after DDAVP administration. Levels of Von Willebrand factor (VWF), VWF propeptide, factor VIII (FVIII), and ADAMTS13 were measured in all plasma samples, whereas VWF multimers and functional VWF-dependent platelet adhesion were determined in the samples pre- and 1 h after DDAVP administration.
Following DDAVP administration, VWF, FVIII, and VWF propeptide levels increased in patients with haemophilia, while patients with cirrhosis only showed an increase in VWF propeptide and FVIII levels. High molecular weight VWF multimers and VWF-dependent platelet adhesion increased in patients with haemophilia one hour after DDAVP administration, but did not change in the patients with cirrhosis. Levels of ADAMTS13 were unaffected in both patient groups after DDAVP.
The lack of relevant effects of DDAVP on laboratory indices of primary hemostasis in patients with cirrhosis is in line with previous clinical study results in these patients.
肝硬化常影响止血的多个环节。这些患者在出血发作时或在侵入性操作前预防性使用时，通常需要纠正凝血功能障碍。虽然 1-脱氨-8-D-精氨酸血管加压素（DDAVP）广泛用作肝硬化患者的促止血剂，但尚不清楚 DDAVP 是否确实能增强这些患者的止血作用。在此，我们研究了肝硬化患者单次推注 DDAVP 的止血效果。
10 例肝硬化（Child B 或 C）患者和 10 例轻度血友病 A 患者接受了 0.3 微克/公斤 DDAVP 的静脉单次推注。在 DDAVP 给药前和给药后 1、3、6 和 24 小时采集血浆。所有血浆样本均测定血管性血友病因子（VWF）、VWF 前肽、VIII 因子（FVIII）和 ADAMTS13 水平，而在 DDAVP 给药前和给药后 1 小时测定 VWF 多聚体和功能性 VWF 依赖性血小板黏附。
DDAVP 给药后，血友病患者的 VWF、FVIII 和 VWF 前肽水平升高，而肝硬化患者仅表现为 VWF 前肽和 FVIII 水平升高。DDAVP 给药 1 小时后，血友病患者的高分子量 VWF 多聚体和 VWF 依赖性血小板黏附增加，但肝硬化患者无变化。DDAVP 给药后，两组患者的 ADAMTS13 水平均无变化。
肝硬化患者 DDAVP 对主要止血实验室指标无相关作用，与之前对这些患者的临床研究结果一致。
