Preoperative Intravenous Desmopressin and Perioperative Blood Loss in Patients Undergoing Major Spine Surgery
Keywords:
Desmopressin; DDAVP; Spine Surgery; Blood Loss; Transfusion; Randomized Controlled TrialAbstract
Background: Major spine surgeries often involve significant blood loss, increasing transfusion risks and postoperative complications. Desmopressin, a synthetic vasopressin analog, may reduce bleeding by enhancing clotting factor release, but its efficacy in spine surgery remains understudied. This study evaluated the efficacy of preoperative intravenous desmopressin in reducing perioperative blood loss and transfusion requirements in patients undergoing major spine surgery. Materials and Methods: A double-blind, randomized, placebo-controlled trial was conducted at Shahid Rajaei Hospital, Iran. Fifty-five patients undergoing major spinal surgery were randomized to receive either 0.3 µg/kg desmopressin (n=25) or placebo (n=30) during anesthesia induction. Primary outcomes included intraoperative blood loss (measured hourly) and transfusion volume. Secondary outcomes included postoperative sodium levels, creatinine, urine output, and hospital stay. Statistical analyses used Student’s t-test, Chi-square, and repeated measures ANOVA. Results: Desmopressin significantly reduced intraoperative blood loss during the first hour (336.00± 125.43 vs. 398.33±85.58 mL, P=0.034) and second hour (530.95±188.07 vs. 756.67 ± 242.65 mL, P=0.003) compared to placebo. Total transfusion volume was lower in the desmopressin group (724.79 ± 429.06 vs. 1396.55±325.94 mL, P=0.001), with fewer intraoperative packed red blood cell transfusions (16% vs. 40%, P = 0.050). Postoperative creatinine levels were lower with desmopressin (1.16 ± 0.30 vs. 1.40 ± 0.32 mg/dL, P=0.009), but sodium levels and urine output were comparable. Hemodynamic stability and hospital stay did not differ significantly. Conclusion: Preoperative desmopressin reduced early intraoperative blood loss and transfusion requirements in major spine surgery without significant adverse effects. These findings support its use as a hemostatic adjunct, though further studies are needed to confirm long-term safety and efficacy.
References
Bess RS, Lenke LG. Blood loss minimization and blood salvage techniques for complex spinal surgery. Neurosurgery Clinics. 2006 Jul 1;17(3):227-34.
https://doi.org/10.1016/j.nec.2006.04.009
Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway?. Annals of surgery. 2007 May 1;245(5):812-8.
https://doi.org/10.1097/01.sla.0000256862.79374.31
Butler JS, Burke JP, Dolan RT, Fitzpatrick P, O'Byrne JM, McCormack D, Synnott K, Poynton AR. Risk analysis of blood transfusion requirements in emergency and elective spinal surgery. European spine journal. 2011 May;20(5):753-8.
https://doi.org/10.1007/s00586-010-1500-0
Carless PA, Moxey AJ, et al. Desmopressin for minimising perioperative allogeneic blood transfusion. Cochrane. 2014; :1884.
Giblett ER. Blood group alloantibodies: an assessment of some laboratory practices. Transfusion. 1977 Jul 8;17(4):299-308.
https://doi.org/10.1046/j.1537-2995.1977.17477216857.x
Goodnough LT, Marcus RE. Effect of autologous blood donation in patients undergoing elective spine surgery. Spine. 1992 Feb 1;17(2):172-5.
https://doi.org/10.1097/00007632-199202000-00009
JOHNSON RG, MURPHY M, MILLER M. Fusions and transfusions: an analysis of blood loss and autologous replacement during lumbar fusions. Spine. 1989 Apr 1;14(4):358-62.
https://doi.org/10.1097/00007632-198904000-00002
Miri M, Farzanegan G, Khosravi N, Rezvani M, Khan ZH, Moradi M. Predictive factors of blood loss and hospital stay in patients with major lumbosacral surgeries: A multi-center, prospective, cross-sectional survey. Arch Neurosci. 2015 Jul 1;2(3):e22804.
https://doi.org/10.5812/archneurosci.22804
Wass CT, Long TR, Faust RJ, Yaszemski MJ, Joyner MJ. Changes in red blood cell transfusion practice during the past two decades: a retrospective analysis, with the Mayo database, of adult patients undergoing major spine surgery. Transfusion. 2007 Jun;47(6):1022-7.
https://doi.org/10.1111/j.1537-2995.2007.01231.x
Zheng F, Cammisa Jr FP, Sandhu HS, Girardi FP, Khan SN. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine. 2002 Apr 15;27(8):818-24.
https://doi.org/10.1097/00007632-200204150-00008
Wang M, Zheng XF, Jiang LS. Efficacy and safety of antifibrinolytic agents in reducing perioperative blood loss and transfusion requirements in scoliosis surgery: a systematic review and meta-analysis. PloS one. 2015 Sep 18;10(9):e0137886.
https://doi.org/10.1371/journal.pone.0137886
Vande Walle J, Stockner M, Raes A, Norgaard JP. Desmopressin 30 years in clinical use: a safety review. Current drug safety. 2007 Sep 1;2(3):232-8.
https://doi.org/10.2174/157488607781668891
Leissinger C, Carcao M, Gill JC, Journeycake J, Singleton T, Valentino L. Desmopressin (DDAVP) in the management of patients with congenital bleeding disorders. Haemophilia. 2014 Mar;20(2):158-67.
https://doi.org/10.1111/hae.12254
Laboratories P. HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use DESMOPRESSIN ACETATE NASAL SPRAY. safely and effectively: pdf; 2018.
del Castillo Alferez J, Smit ER, Meijer AB, Fijnvandraat K, Kruip MJ, van Duijl TT, van den Biggelaar M. Plasma proteomics in patients with von Willebrand disease and hemophilia A highlights von Willebrand factor as main determinant of response to desmopressin treatment. Research and Practice in Thrombosis and Haemostasis. 2025 Mar 1;9(3):102738.
https://doi.org/10.1016/j.rpth.2025.102738
Mannucci PM. Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years. Blood, The Journal of the American Society of Hematology. 1997 Oct 1;90(7):2515-21.-Sh Raja YS. Desmopressin for Haemostasis in Cardiac Surgery: When to Use? Annals of Cardiac Anaesthesia 2006.
https://doi.org/10.1182/blood.V90.7.2515.2515_2515_2521
Sh Raja YS. Desmopressin for Haemostasis in Cardiac Surgery: When to Use? Annals of Cardiac Anaesthesia 2006.
https://doi.org/10.4103/0971-9784.37907
Theusinger OM, Spahn DR. Perioperative blood conservation strategies for major spine surgery. Best Practice & Research Clinical Anaesthesiology. 2016;30(1):41-52.
https://doi.org/10.1016/j.bpa.2015.11.007
Ozier Y, Bellamy L. Pharmacological agents: antifibrinolytics and desmopressin. Best Practice & Research Clinical Anaesthesiology. 2010;24(1):107-19.
https://doi.org/10.1016/j.bpa.2009.09.014
KOBRINSKY NL, LETTS RM, PATEL LR, ISRAELS ED, MONSON RC, SCHWETZ N, CHEANG MS. 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. Annals of internal medicine. 1987 Oct 1;107(4):446-50.
https://doi.org/10.7326/0003-4819-107-4-446
Guay J, Reinberg C, Poitras B, David M, Mathews S, Lortie L, Rivard GE. A trial of desmopressin to reduce blood loss in patients undergoing spinal fusion for idiopathic scoliosis. Anesthesia & Analgesia. 1992 Sep 1;75(3):405-10.
https://doi.org/10.1213/00000539-199209000-00016
Hu SS. Blood loss in adult spinal surgery. Eur Spine J. 2004;13 Suppl 1:S3-5.
https://doi.org/10.1007/s00586-004-0753-x
Letts M, Pang E, D'Astous J, Jarvis J, Lawton L, Luke B, Rhine E, Menard E. The influence of desmopressin on blood loss during spinal fusion surgery in neuromuscular patients. Spine. 1998 Feb 15;23(4):475-8.
https://doi.org/10.1097/00007632-199802150-00014
Theroux MC, Corddry DH, Tietz AE, Miller F, Peoples JD, Kettrick RG. A study of desmopressin and blood loss during spinal fusion for neuromuscular scoliosis: a randomized, controlled, double-blinded study. Anesthesiology. 1997 Aug 1;87(2):260-7.
https://doi.org/10.1097/00000542-199708000-00012
ECKARDT JJ, GOSSETT TC, AMSTUTZ HC. Autologous transfusion and total hip arthroplasty. Clinical Orthopaedics and Related Research®. 1978 May 1(132):39-45.
https://doi.org/10.1097/00003086-197805000-00009
Colombo P, Passini E, Re T, Faglia G, Ambrosi B. Effect of desmopressin on ACTH and cortisol secretion in states of ACTH excess. Clinical endocrinology. 1997 Jun;46(6):661-8.
https://doi.org/10.1046/j.1365-2265.1997.1330954.x
Foppiani L, Sessarego P, Valenti S, Falivene MR, Cuttic CM, Disem MG. Lack of effect of desmopressin on ACTH and cortisol responses to ovine corticotropin‐releasing hormone in anorexia nervosa. European journal of clinical investigation. 1996 Oct;26(10):879-83.
https://doi.org/10.1111/j.1365-2362.1996.tb02133.x
Giraldi FP, Marini E, Torchiana E, Mortini P, Dubini A, Cavagnini F. Corticotrophin-releasing activity of desmopressin in Cushing's disease: lack of correlation between in vivo and in vitro responsiveness. Journal of endocrinology. 2003 Jun 1;177(3):373-9.
https://doi.org/10.1677/joe.0.1770373
Clagett GP, Valentine RJ, Myers SI, Chervu A, Heller J. Does desmopressin improve hemostasis and reduce blood loss from aortic surgery A randomized, double-blind study. Journal of vascular surgery. 1995 Sep 1;22(3):223-30.
https://doi.org/10.1016/S0741-5214(95)70134-6
Jin L, Ji HW. Effect of desmopressin on platelet aggregation and blood loss in patients undergoing valvular heart surgery. Chin Med J (Engl). 2015;128(5):644-7.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Galen Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
