Desmopressin for treatment of thrombocytopenia or platelet dysfunction

Desborough, MJR

Abstract:: The objective of the work presented in this thesis was to explore the role of potential alternatives to platelet transfusions and specifically to investigate whether desmopressin could be used for treatment of thrombocytopenia or platelet dysfunction. Patients with thrombocytopenia or platelet dysfunction are often treated with platelet transfusions to treat or prevent bleeding. However the evidence for the efficacy of platelet transfusion is limited and there is some evidence of harm. I h...
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APA Style

Desborough, M. J. R. (2017). Desmopressin for treatment of thrombocytopenia or platelet dysfunction [PhD thesis]. University of Oxford.

MLA Style

Desborough, M. JR. Desmopressin for Treatment of Thrombocytopenia or Platelet Dysfunction. University of Oxford, 2017.

Chicago Style

Desborough, MJR. 2017. “Desmopressin for Treatment of Thrombocytopenia or Platelet Dysfunction.” PhD thesis, University of Oxford.
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Files:: Revised thesis - final.pdf

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Authors

+ Desborough, MJR More by this author

Division:: MSD
Department:: University of Oxford
Role:: Author

Contributors

+ Stanworth, SJ

Department:: University of Oxford
Role:: Supervisor

+ Estcourt, LJ

Role:: Supervisor

+ NHS Blood and Transplant More from this funder

Funding agency for:: Desborough, MJR

DOI:: 10.5287/ora-2axn8nqdb
Type of award:: DPhil
Level of award:: Doctoral
Awarding institution:: University of Oxford

Language:: English
Keywords:: Anti-platelet drugs

Systematic review

Meta-analysis

Platelets

Clinical trial

Aspirin

Desmopressin

Transfusion
Subjects:: Medicine

Haematology
UUID:: uuid:4de19720-328a-4d01-9153-02dec6202aff
Deposit date:: 2018-02-28

Related item:: Alternatives to allogeneic platelet transfusion
Description:: Allogeneic platelet transfusions are widely used for the prevention and treatment of bleeding in thrombocytopenia. Recent evidence suggests platelet transfusions have limited efficacy and are associated with uncertain immunomodulatory risks and concerns about viral or bacterial transmission. Alternatives to transfusion are a well-recognised tenet of Patient Blood Management, but there has been less focus on different strategies to reduce bleeding risk by comparison to platelet transfusion. Direct alternatives to platelet transfusion include agents to stimulate endogenous platelet production (thrombopoietin mimetics), optimising platelet adhesion to endothelium by treating anaemia or increasing von Willebrand factor levels (desmopressin), increasing formation of cross-linked fibrinogen (activated recombinant factor VII, fibrinogen concentrate or recombinant factor XIII), decreasing fibrinolysis (tranexamic acid or epsilon aminocaproic acid) or using artificial or modified platelets (cryopreserved platelets, lyophilised platelets, haemostatic particles, liposomes, engineered nanoparticles or infusible platelet membranes). The evidence base to support the use of these alternatives is variable, but an area of active research. Much of the current randomised controlled trial focus is on evaluation of the use of thrombopoietin mimetics and anti-fibrinolytics. It is also recognised that one alternative strategy to platelet transfusion is choosing not to transfuse at all.
Related item:: Desmopressin use for minimising perioperative blood transfusion
Description:: BACKGROUND:Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed.OBJECTIVES:To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders.SEARCH METHODS:We s...
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Related item:: Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta-analysis of randomized controlled trials
Description:: ESSENTIALS:The optimal management of patients with platelet dysfunction undergoing surgery is unclear. This meta-analysis compared perioperative administration of desmopressin to placebo. Desmopressin reduced red cell transfusions, blood loss and risk of re-operation due to bleeding. There were too few events to determine if there was a change in the risk of thrombotic events.SUMMARY:Background Platelet dysfunction, including that caused by antiplatelet agents, increases the risk of perioperative bleeding. The optimal management of patients with platelet dysfunction undergoing surgery is unclear. Objectives To assess whether desmopressin reduces perioperative allogeneic red cell transfusion and bleeding in patients with platelet dysfunction. Patients/Methods We searched for randomized controlled trials in The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, the Transfusion Evidence Library and the ISI Web of Science to 7th July 2016. Data were pooled using mean difference (MD), relative risks or Peto odds ratios (pOR) using a random-effects model. Results Ten trials with 596 participants were identified, all in the setting of cardiac surgery. Platelet dysfunction was due to antiplatelet agents in six trials and cardiopulmonary bypass in four trials. Patients treated with desmopressin were transfused with fewer red cells (MD, -0.65 units; 95% Confidence Interval [CI], -1.16 to -0.13 units), lost less blood (MD, -253.93 mL; 95% CI, -408.01 to -99.85 mL) and had a lower risk of re-operation due to bleeding (pOR, 0.39; 95% CI, 0.18-0.84). The GRADE quality of evidence was very low to moderate, suggesting considerable uncertainty over the results Conclusions Desmopressin may be a useful agent to reduce bleeding and transfusion requirements for people with platelet dysfunction or with a history of recent antiplatelet drug administration undergoing cardiac surgery.

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Desmopressin for treatment of thrombocytopenia or platelet dysfunction

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