Perioperative administration of a single dose of conjugated oestrogen to uraemic patients is ineffective in improving haemostasis.

The excessive bleeding that occurs in uraemic patients undergoing surgery is reported to be reversed by at least one schedule of prior oestrogen administration. To assess this possibility a single intravenous injection of 25 mg of the conjugated hormone was given to ten uraemic patients undergoing regular haemodialysis and randomly compared to eight matched patients who received only the diluent. Two hours later there was no reduction in bleeding time, improvement in platelet aggregation, nor an increase in plasma levels of factor VIII (VIII:C), von Willebrand factor (VWF:Ag), or the factor VIII-related ristocetin cofactor state. Furthermore, there was no reduction in intraoperative blood loss, being a median of 558 +/- 154 (range 225-1,260) mL in the test group and 412 +/- 55 (range 270-555) mL in the control and additional median postoperative portovac drainage was 123 +/- 27 (range 0-170) mL and 153 +/- 41 (range 45-240) mL, respectively. These findings differ from the shortening in bleeding time achieved by others with repeated administration of the same agent, and emphasize the importance of dose and duration of oestrogen therapy when used for this indication.