Summary
The response of components of the coagulation and fibrinolysis systems to infusion
of DDAVP has been examined in patients undergoing elective surgery. In the DDAVP treated
group there was a significant increase, compared to control, in plasminogen activator
(by fibrin plates p <0.005, ECLT p <0.0125, by Student’s t test) before operation.
No difference between groups was seen by either methods in the activator levels in
samples 24 h postoperation, whereas a significant drop (p <0.002) in protein C concentration
was observed at this stage in the treated group. Levels of factor VIII components
were significantly higher (p <0.005) than control at all stages of operation and a
significant shortening (5 sec p <0.05) of the APTT was seen at all stages (apart from
24 h samples). DDAVP infusion therefore may exacerbate the hypercoagulable state observed
in surgical patients without preventing the (post-operatively) fibrinolytic shutdown.
Instead, infusion tends to produce fibrinolytic depletion at the key mid-operative
stage.
Key words
Plasminogen activator - Factor VIII components - Protein C - Haemostasis - DDAVP
