Effects of deamino-8-D-arginin vasopressin on blood loss and coagulation factors in scoliosis surgery - A double-blind randomized clinical trial

Study Design. A double-blind, randomized, prospective clinical study was pe rformed to evaluate the efficacy of deamino-8-D-arginin vasopressin in redu cing blood loss in major scoliosis surgery. Objectives. To evaluate whether desmopressin has any effect on reducing blo od loss in spinal surgery, to identify the probable mechanisms of effective ness via blood coagulation factors, and to outline any adverse effect assoc iated with the use of deamino-8-D-arginin vasopressin. Summary of Background Data. Scoliosis surgery is known to be associated wit h major blood loss. Because of major drawbacks of homologous blood transfus ion, many alternative methods have been used to counter the blood loss. Onl y a few studies exist, with controversial results, on the use of deamino-8- D-arginin vasopressin. Methods. The study population included 40 operations on 35 consecutive pati ents undergoing reconstructive surgery for either idiopathic (n = 26) or co ngenital (n = 9) scoliosis. Operations were randomized into deamino-8-D-arg inin vasopressin (0.3 mu g/kg body weight; maximum, 20 mu g) (n = 18) or pl acebo (n = 22) groups and stratified according to the diagnosis and the typ e of surgery performed (i.e., anterior versus posterior versus anterior and posterior sequential). Parameters of blood loss, serum levels of blood coa gulation factors at different time intervals, and urinary output were measu red. Results. Findings indicated that blood loss per kilogram of body weight, bl ood loss per surgically treated spinal level, urinary output per kilogram o f body weight and serum levels of fibrinogen, von Willebrand factor (VWF) a ctivity, tissue type plasminogen activator activity, and plasminogen activa tor inhibitor activity were not sensitive to the administration of deamino- 8-D-arginin vasopressin at any time interval during surgery or at 24 hours after surgery (P > 0.05). Only factor VIII:C levels exhibited significant e levations at 30 minutes and at 24 hours (P < 0.05). Conclusions. This study could not demonstrate any significant effect of dea mino-8-D-arginin vasopressin on the amount of blood loss in a group of pati ents with idiopathic or congenital scoliosis. Findings indicate that for mo st of the coagulation factors, any changes in serum levels induced by deami no-8-D-arginin vasopressin were much like those expected from surgery itsel f. This study also failed to demonstrate any significant effects altering t he urinary output that may be attributed to the use of deamino-8-D-arginin vasopressin.