Agnelli G, Parise P, Levi M, Cosmi B, Nenci G G
Institute of Internal and Vascular Medicine, University of Perugia, Italy.
Haemostasis. 1995 Sep-Oct;25(5):241-7. doi: 10.1159/000217167.
The aim of this double-blind, placebo-controlled crossover study was to investigate the effect of 1-deamino-8-D-arginine vasopressin (dDAVP) on hemostasis in patients with chronic liver disease. Nine consecutive patients with biopsy-proven liver cirrhosis and related coagulation abnormalities received in a random order dDAVP, 0.5 microgram/kg, or saline intravenously. Blood samples were taken before dDAVP infusion and 30, 60 and 180 min after its end. dDAVP infusion induced a statistically significant shortening of the bleeding time from 9 min (range 6.5-15.5) to 6 min (range 4.5-9.5) at 1 h after the infusion. The activated partial thromboplastin time was significantly shortened at 30 and 60 min after dDAVP infusion. Plasma levels of factor VIII, XI and XII coagulant activities were significantly increased at all sampling times after dDAVP infusion. The maximum increase over basal values in plasma levels of factor VIII, XI and XII was 63, 22 and 40%, respectively. dDAVP did not induce any significant changes of prothrombin time, thrombin clotting time, fibrinogen, plasma levels of factor II, V, VII, IX, X, factor XII antigen, protein C (activity and antigen), antithrombin III, plasminogen and alpha 2-antiplasmin. Placebo infusion did not produce any significant changes in the evaluated parameters. We conclude that dDAVP can positively influence the hemostatic system in patients with liver cirrhosis. The clinical relevance of this hemostatic improvement deserves further evaluation.
这项双盲、安慰剂对照的交叉研究旨在调查1-去氨基-8-D-精氨酸加压素（dDAVP）对慢性肝病患者止血的影响。9例经活检证实为肝硬化且伴有相关凝血异常的连续患者，随机接受静脉注射dDAVP（0.5微克/千克）或生理盐水。在注射dDAVP前以及注射结束后30、60和180分钟采集血样。注射dDAVP后1小时，出血时间从9分钟（范围6.5 - 15.5分钟）显著缩短至6分钟（范围4.5 - 9.5分钟）。注射dDAVP后30和60分钟时，活化部分凝血活酶时间显著缩短。注射dDAVP后所有采样时间点，血浆中凝血因子VIII、XI和XII的凝血活性均显著增加。凝血因子VIII、XI和XII的血浆水平相对于基础值的最大增幅分别为63%、22%和40%。dDAVP未引起凝血酶原时间、凝血酶凝血时间、纤维蛋白原、血浆中凝血因子II、V、VII、IX、X、凝血因子XII抗原、蛋白C（活性和抗原）、抗凝血酶III、纤溶酶原和α2 - 抗纤溶酶的任何显著变化。安慰剂注射对所评估参数未产生任何显著变化。我们得出结论，dDAVP可对肝硬化患者的止血系统产生积极影响。这种止血改善的临床相关性值得进一步评估。
