Intranasal desmopressin versus blood transfusion in cirrhotic patients with coagulopathy undergoing dental extraction: a randomized controlled trial.

Abstract

PURPOSE:

Cirrhotic patients waiting for liver transplantation who need dental extractions are given fresh frozen plasma and/or platelets to correct coagulopathy. This is costly and may be associated with transfusion reactions and fluid overload. We evaluated the efficacy of intranasal desmopressin as an alternative to transfusion to correct the coagulopathy of cirrhotic patients undergoing dental extraction.

PATIENTS AND METHODS:

Cirrhotic patients with platelet counts of 30,000 to 50,000/microL and/or international normalized ratio (INR) 2.0 to 3.0 were enrolled in a prospective, controlled, randomized clinical trial. Blood transfusion (fresh frozen plasma 10 mL/kg and/or 1 unit of single donor platelets, respectively) or intranasal desmopressin (300 microg) were given before dental extraction. A standard oral and maxillofacial surgical treatment protocol was performed by the same surgeon. Patients were followed for postextraction bleeding and side-effects over the next 24 to 48 hours.

RESULTS:

No significant differences were noted between the 2 groups in gender, age, INR, platelet count, creatinine, total bilirubin, ALT, albumin, MELD score, or number of teeth removed (median 3 vs 4). The number of teeth removed ranged between 1 and 31 in the desmopressin group and 1 and 22 in the transfusion group. No patients in desmopressin group required rescue blood transfusion after extraction. One patient in the transfusion group had bleeding after the procedure and required an additional transfusion. Another patient experienced an allergic reaction at the end of transfusion, which was effectively treated with diphenhydramine. Treatment associated average costs were lower for desmopressin ($700/patient) compared with transfusion ($1,173/patient).

CONCLUSIONS:

Intranasal desmopressin was as effective as blood transfusion in achieving hemostasis in cirrhotic patients with moderate coagulopathy undergoing dental extraction. Intranasal desmopressin was much more convenient, less expensive, and well tolerated.

• Authors: Carmen M Stanca, Andre H Montazem, Adeyemi Lawal, Jin X Zhang, Thomas D Schiano
• Journal: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg) Vol. 68 Issue 1 Pg. 138-43 (Jan 2010) ISSN: 1531-5053 [Electronic] United States
• PMID: 20006168 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Hemostatics
• Deamino Arginine Vasopressin

Topics

• Administration, Intranasal
• Adult
• Blood Coagulation Disorders (complications, drug therapy)
• Blood Loss, Surgical (prevention & control)
• Blood Transfusion
• Deamino Arginine Vasopressin (administration & dosage)
• Female
• Hemostatics (administration & dosage)
• Humans
• International Normalized Ratio
• Liver Cirrhosis (blood, complications, surgery)
• Liver Transplantation
• Male
• Middle Aged
• Plasma
• Platelet Count
• Platelet Transfusion
• Premedication
• Tooth Extraction