EFFECTS OF DESMOPRESSIN ON HEMOSTASIS IN PATIENTS WITH LIVER-CIRRHOSIS

The aim of this double-blind, placebo-controlled crossover study was t o investigate the effect of 1-deamino-8-D-arginine vasopressin (dDAVP) on hemostasis in patients with chronic liver disease. Nine consecutiv e patients with biopsy-proven liver cirrhosis and related coagulation abnormalities received in a random order dDAVP, 0.5 mu g/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 pa rtial thromboplastin time was significantly shortened at 30 and 60 min after dDAVP infusion. Plasma levels of factor VIII, XI and XII coagul ant activities were significantly increased at all sampling times afte r dDAVP infusion. The maximum increase over basal values in plasma Lev els 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 produ ce any significant changes in the evaluated parameters. We conclude th at dDAVP can positively influence the hemostatic system in patients wi th liver cirrhosis. The clinical relevance of this hemostatic improvem ent deserves further evaluation.