NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
Oxford Clinical Research in Transfusion Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK.
J Thromb Haemost. 2017 Feb;15(2):263-272. doi: 10.1111/jth.13576. Epub 2017 Feb 8.
Essentials The optimal management of patients with platelet dysfunction undergoing surgery is unclear. This meta-analysis compared perioperative administration of desmopressin to placebo. Desmopressin reduced red cell transfusions, blood loss and risk of re-operation due to bleeding. There were too few events to determine if there was a change in the risk of thrombotic events.
Background Platelet dysfunction, including that caused by antiplatelet agents, increases the risk of perioperative bleeding. The optimal management of patients with platelet dysfunction undergoing surgery is unclear. Objectives To assess whether desmopressin reduces perioperative allogeneic red cell transfusion and bleeding in patients with platelet dysfunction. Patients/Methods We searched for randomized controlled trials in The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, the Transfusion Evidence Library and the ISI Web of Science to 7th July 2016. Data were pooled using mean difference (MD), relative risks or Peto odds ratios (pOR) using a random-effects model. Results Ten trials with 596 participants were identified, all in the setting of cardiac surgery. Platelet dysfunction was due to antiplatelet agents in six trials and cardiopulmonary bypass in four trials. Patients treated with desmopressin were transfused with fewer red cells (MD, -0.65 units; 95% Confidence Interval [CI], -1.16 to -0.13 units), lost less blood (MD, -253.93 mL; 95% CI, -408.01 to -99.85 mL) and had a lower risk of re-operation due to bleeding (pOR, 0.39; 95% CI, 0.18-0.84). The GRADE quality of evidence was very low to moderate, suggesting considerable uncertainty over the results Conclusions Desmopressin may be a useful agent to reduce bleeding and transfusion requirements for people with platelet dysfunction or with a history of recent antiplatelet drug administration undergoing cardiac surgery.
目的 血小板功能障碍（包括抗血小板药物引起的血小板功能障碍）增加了围手术期出血的风险。血小板功能障碍患者行手术治疗的最佳管理方案尚不明确。
方法 我们检索了 Cochrane 对照试验中心注册库、MEDLINE、PubMed、Embase、输血证据库和 ISI Web of Science 至 2016 年 7 月 7 日的随机对照试验。采用随机效应模型，使用均数差值（MD）、相对危险度或 Peto 比值比（pOR）进行数据合并。
结果 共纳入 10 项试验，涉及 596 例患者，均为心脏手术背景下的研究。6 项试验中的血小板功能障碍归因于抗血小板药物，4 项试验中的血小板功能障碍归因于心肺旁路。与安慰剂相比，使用去氨加压素治疗的患者输注的红细胞较少（MD，-0.65 单位；95%置信区间[CI]，-1.16 至-0.13 单位），失血较少（MD，-253.93 毫升；95%CI，-408.01 至-99.85 毫升），且因出血再次手术的风险较低（pOR，0.39；95%CI，0.18-0.84）。GRADE 证据质量为极低至中度，提示对结果存在较大不确定性。
结论 对于血小板功能障碍或近期使用抗血小板药物的心脏手术患者，去氨加压素可能是一种减少出血和输血需求的有用药物。
