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1-Desamino-8-D-arginine Vasopressin (Desmopressin) Decreases Operative Blood Loss in Patients Having Harrington Rod Spinal Fusion Surgery: A Randomized, Double-Blinded, Controlled Trial

NATHAN L. KOBRINSKY, M.D.; R. MERV LETTS, M.D.; LEENA R. PATEL, M.D.; ESTHER D. ISRAELS, M.D.; RONALD C. MONSON, M.D.; NORA SCHWETZ, R.N., B.Sc.; and MARY S. CHEANG, M.Math
[+] Article and Author Information

Grant support: in part by the Children's Hospital of Winnipeg Research Foundation. Desmopressin was provided by Richmond Pharmaceuticals, Inc. (Richmond, Ontario, Canada).

▸Requests for reprints should be addressed to Nathan L. Kobrinsky; Manitoba Cancer Treatment and Research Foundation, 100 Olivia Street; Winnipeg, Manitoba, R3E OV9, Canada.


Winnipeg, Manitoba, Canada


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;107(4):446-450. doi:10.7326/0003-4819-107-4-446
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To evaluate the effect of 1-desamino-8-D-arginine vasopressin (desmopressin) on blood loss in surgery, we conducted a randomized, double-blind trial of the drug in 35 patients with normal hemostatic function who were having spinal fusion with Harrington rod instrumentation. Seventeen patients were designated to receive 10μg/m2 of desmopressin, and 18, to receive a placebo. Preoperative testing showed that desmopressin increased factor VIII coagulant activity, von Willebrand antigen concentrations, glass bead platelet retention, and prothrombin consumption and decreased the partial thromboplastin and bleeding times (p ≤ 0.0003). During surgery, desmopressin reduced blood loss by 32.5% (547 mL; 95% confidence interval [CI], 19 to 1075; p = 0.015) and reduced the need for concentrated erythrocyte transfusions by 25.6% (0.86 units; 95% CI, 0.08 to 1.65; p = 0.022). After surgery, desmopressin reduced the duration of treatment with analgesic agents by 13.1% (34.0 hours; 95% CI, — 5.2 to 72.7; p = 0.105), presumably by decreasing bleeding in the surgical wound. When adjusted for the origin of the scoliosis by two-way analysis of variance, this effect was even more evident (p = 0.014). Multiple regression analysis showed that the best three predictors of blood loss in surgery and transfusion requirements were the bleeding time, glass bead platelet retention, and the use of desmopressin.

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