A Cochrane review [Abstract] 1 included 29 studies with a total of 2 171 subjects. Desmopressin acetate (1-deamino-8-D-arginine-vasopressin, DDAVP) did not significantly reduce the risk of exposure to allogeneic red blood cell (RBC) transfusion (RR 0.96, 95% CI 0.87 to 1.06; 19 studies, n= 1387). However, the use of DDAVP significantly reduced total blood loss (WMD -241.78 ml, 95% CI -387.55 to -96.01 ml; 10 studies, n= 669). Although DDAVP appeared to reduce the overall volume of allogeneic blood transfused during the peri-operative period the result would not be considered clinically significant (WMD -0.3 units, 95% CI -0.60 to -0.01 units; 14 studies, n= 885). Risk of re-operation due to bleeding was not reduced (RR 0.69, 95% CI 0.26 to 1.83; 11 studies, n= 778). DDAVP treatment was not associated with an increased risk of death or myocardial infarction (RR 1.72, 95% CI 0.68 to 4.33, 12 studies, n= 1061; RR 1.38, 95% CI 0.77 to 2.50, 12 studies, n= 876, respectively).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).
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