Does desmopressin reduce bleeding in liver surgery? An experimental study on pigs

The main problem with liver surgery is to control intraoperative bleeding. Bleeding together with postoperative infection and liver failure are the most common causes of postoperative morbidity and mortality in liver surgery. Hospitals with experience of liver resection, report postoperative mortality rates of 3.2%-14.3%. Improved results in liver surgery have been made by refinement of surgical methods and modern techniques. Desmopressin acetate (Octostim) reduces bleeding time by activating platelets and increasing the level of coagulation factor VIII. The purpose with this study was to see if desmopressin could reduce bleeding in a standardized experimental liver resection. Sixteen Swedish domestic pigs were randomized to receive desmopressin 0.3 ug/kg i.v. or placebo, and underwent liver resection with conventional finger fracture technique. The intraoperative blood loss was estimated by several parameters such as pre and postoperative haemoglobin values and by weighing the number of gauze swabs used. One week postoperatively new haemoglobin samples were taken and the pigs were killed. At autopsy the resection area was inspected. All sixteen pigs survived the operation and the postoperative week. There was no significant difference in blood loss between the desmopressin and placebo group. In conclusion, our study showed that desmopressin did not reduce intraoperative bleeding in experimental liver resection.