Cattaneo M, Harris A S, Strömberg U, Mannucci P M
A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital, University of Milano, Italy.
Thromb Haemost. 1995 Oct;74(4):1064-70.
The effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (> 1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.
去氨加压素（DDAVP）对减少心脏手术后失血的效果已在多项随机临床试验中进行了研究，但结果相互矛盾。由于大多数试验的统计效力不足，无法检测出血液流失的真正差异，我们对相关研究的数据进行了荟萃分析。分析了17项随机、双盲、安慰剂对照试验，其中包括1171名因各种适应症接受心脏手术的患者；其中579人接受去氨加压素治疗，592人接受安慰剂治疗。疗效参数为失血量和输血需求。去氨加压素显著减少术后失血量9%，但对输血需求无统计学显著影响。一项亚分析显示，在安慰剂治疗患者的平均失血量处于失血量分布的下三分之一和中三分之一（687 - 1108 ml/24 h）的试验中，去氨加压素没有保护作用。相比之下，在安慰剂治疗患者的平均失血量处于分布上三分之一（> 1109 ml/24 h）的试验中，去氨加压素显著减少术后失血量34%。没有足够的数据对输血需求进行亚分析。因此，去氨加压素仅在导致大量失血的心脏手术中显著减少失血量。需要进一步的研究来验证这项荟萃分析的结果，并确定心脏手术后大量失血的预测因素。
