European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Mar 1997
ReviewPharmacological prophylaxis of bleeding in surgical patients treated with aspirin.
A Medline search and subsequent meta-analysis shows that pre-operative aspirin increases blood loss and transfusion requirements in patients undergoing coronary artery bypass grafting. Both aprotinin and desmopressin are effective in counteracting this. There are almost no data on the effects of bleeding of aspirin, aprotinin and desmopressin in other procedures.
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Eur J Anaesthesiol Suppl · Mar 1997
ReviewDesmopressin--a haemostatic drug: state-of-the-art review.
Desmopressin is a well tolerated and convenient haemostatic drug that can be used in a number of clinical conditions with bleeding diathesis. It has several effects on the haemostatic system, causing endogenous release of coagulation factor VIII, von Willebrand factor, tissue plasminogen activator and also increasing platelet adhesiveness and shortening bleeding time. The effect is virtually immediate and lasts for several hours. ⋯ The optimal dosage is 0.3 microgram kg-1 intravenously, but the drug may also be administered subcutaneously or intranasally. In addition to the established indications, haemophilia A, von Willebrand's disease and platelet dysfunction, the drug may also be used safely in other patients with unexpected bleeding during or after surgery. The effectiveness of general prophylactic use of desmopressin, in order to diminish surgical blood loss and transfusion requirements, has not been proven, except in patients with known bleeding diathesis caused by congenital or acquired haemostatic disorders, e.g. in those taking aspirin.
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Peri-operative bleeding is associated with invasive surgery and has traditionally been compensated for by blood transfusion. Concerns about the risk of transfusion-transmitted disease have led to an increasing interest in synthetic haemostatic agents. ⋯ Clinical trials using desmopressin in open cardiac surgery indicate that it may reduce blood loss in those with an excessive bleeding tendency. However, it is difficult to identify this group pre-operatively.
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Eur J Anaesthesiol Suppl · Mar 1997
ReviewReview of clinical experience of desmopressin in patients with congenital and acquired bleeding disorders.
This paper discusses clinical experience of the use of desmopressin in patients with either congenital or acquired bleeding disorders. The bleeding disorders reviewed herein are haemophilia A, von Willebrand's disease and platelet function disorders (congenital bleeding disorders); uraemia, liver cirrhosis and drug-induced bleeding (acquired bleeding disorders).