Possible benefit of preoperative blood deposit for abdominal surgery.

Predictors for the need of blood transfusion were analyzed using multiple regression analysis in 1689 patients undergoing elective major abdominal surgery before the age of 80 years and with a preoperative blood hemoglobin concentration above 110 g/L. Rectal surgery for malignant disease and pancreatic surgery (for malignant or benign disease) were associated with higher transfusion requirements (mean 2.4 units) than other operations (0.

Pharmacological 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.

Measurement of blood loss in clinical studies.

Direct measurement of blood loss has poor reliability and poor validity. A formula is proposed for how blood loss may be calculated from pre- and post-operative haemoglobin, taking the influence of any blood transfusions into account.

The UK guidelines for the use of desmopressin in patients with von Willebrand's disease. Von Willebrand Working Party of the United Kingdom Haemophilia Centre Director's Organization.

A document entitled Guidelines for the Diagnosis and Management of von Willebrand's Disease was produced by the von Willebrand Working Party of the United Kingdom Haemophilia Centre Directors' Organization. Under the chairmanship of Dr Beverley Hunt, an independent board of haematologists and anaesthesiologists reviewed the use of a synthetic vasopressin analogue, desmopressin (DDAVP), in the management of patients with von Willebrand's disease. The Advisory Board considered that production of the guidelines was to be applauded, but that the contraindications for DDAVP were imprecisely defined and may thus be misleading.

Risk factors for major thromboembolism and bleeding tendency after elective general surgical operations. The Fragmin Multicentre Study Group.

Objective: To elucidate those factors that contribute to the risk of major postoperative thromboembolism and perioperative bleeding tendency.

Design: Retrospective multiple logistic regression analysis.

Setting: 7 Scandinavian hospitals (6 Swedish and 1 Norwegian).

Autologous blood transfusion in hip replacement. No effect on blood loss but less increase of plasminogen activator inhibitor in a randomized series of 80 patients.

80 patients underwent total hip replacement (THR) for primary coxarthrosis. In a randomized study, half of them donated 2 units of blood before operation. One unit was collected 4 weeks and one 2 weeks before the scheduled THR.

Thromboprophylaxis with a low molecular weight heparin (tinzaparin) in emergency abdominal surgery. A double-blind multicenter trial.

In this prospective randomized double-blind study the thromboprophylactic effect of postoperative low molecular weight heparin (tinzaparin) was compared with placebo in 80 patients undergoing emergency abdominal surgery. The fibrinogen uptake test was used but because of withdrawal of the labelled fibrinogen from the market the calculated number of patients was not reached. However, this is one of the few studies in emergency abdominal surgery we thought it important to report.

Clinical relevance of the fibrinogen uptake test in patients undergoing elective general abdominal surgery--relation to major thromboembolism and mortality. Fragmin Multicentre Study Group.

Postoperative thromboembolic complications were evaluated in 2578 patients undergoing elective abdominal surgery, all receiving prophylaxis with low molecular weight heparin. A positive fibrinogen uptake test (FUT) developed in 217 patients (8.4%), while 37 patients (1.

Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 XaI units in 2070 patients.

The optimal administration regimens of low molecular weight heparins (LMWHs) have not yet been established. The aim of this study was to compare the efficacy and safety of 2500 and 5000 XaI units of the LMWH dalteparin in patients undergoing elective general surgery for malignant and benign abdominal disease. Prophylaxis was started in the evening before surgery and given once-daily every evening thereafter.

Use of desmopressin to prevent bleeding complications in patients treated with aspirin.

Aspirin induces a haemorrhagic diathesis that persists for at least 1 week after discontinuation of the drug. The effect of the vasopressin analogue desmopressin was studied in 12 patients treated with aspirin who were undergoing cholecystectomy. Desmopressin was given to six of these patients.

Thromboprophylaxis in emergency surgery.

Except for hip fracture surgery, emergency surgery has been only exceptionally studied concerning thromboprophylaxis. There are, however, several reasons to believe the frequency to be fairly high and that the patient group would be in need of prophylaxis. This paper discusses various emergency situations and also gives the design for an ongoing controlled study on the effect of postoperative start of thromboprophylaxis with low molecular weight heparin in emergency abdominal surgery.

Renal effects of high dose desmopressin and dextran. A study in normal subjects and in patients undergoing total hip replacement.

Dextran 70 and the haemostatically active vasopressin analogue desmopressin were administered to four healthy volunteers and to 12 patients undergoing total hip replacement. In volunteers the antidiuretic effect of a single i.v.

Hemostatic effects of ephedrine.

The effects of ephedrine on coagulation and on fibrinolysis were studied in six healthy volunteers. Six volunteers, matched by age and sex, served as untreated controls. Ephedrine was found to significantly prolong mean bleeding time by 2 minutes.

Effects of desmopressin on blood loss in hip arthroplasty. Controlled study in 50 patients.

50 patients undergoing elective total hip replacement under epidural anesthesia and dextran infusion were given two doses of the vasopressin analogue desmopressin 0.3 micrograms/kg BW or placebo in a double-blinded randomized prospective study. Intraoperative blood loss and drainage loss did not differ significantly between groups, but desmopressin reduced the mean total blood loss (calculated from hemoglobin decrease and blood transfusions) by 310 mL (P less than 0.

Effects on coagulation and fibrinolysis of desmopressin in patients undergoing total hip replacement.

Twelve patients undergoing total hip replacement, with regional anaesthesia and with dextran infusion for plasma expansion and thromboprophylaxis, were given the vasopressin analogue desmopressin (DDAVP) or placebo in a randomized, double-blind prospective study. In controls (n = 6) we found a prolongation of the bleeding time, low factor VIII (FVIII) and von Willebrand factor (vWF) and a decrease in antithrombin III to levels known to be at risk for venous thrombosis. Desmopressin shortened postoperative bleeding time, gave an early FVIII/vWF complex increase, prevented antithrombin III from falling to critically low values and appeared to activate the fibrinolytic system, both by tPA increase and PAI-1 decrease.

Effects of desmopressin and dextran on coagulation and fibrinolysis in healthy volunteers.

The effects of desmopressin and dextran on haemostasis and fibrinolysis were studied in four healthy volunteers. Both drugs were compared to placebo, each volunteer being subject to four experiments. Dextran 70 (30 g i.

Blood loss in total hip replacement. A retrospective study.

Two hundred and twelve total hip replacements performed in one clinic over 1 year were reviewed. The mean operative time was 89 min and mean total blood loss 1090 ml. Homologous blood was administered to 74% of the patients.