RESUMO
The synthetic vasopressin derivative desmopressin (DDAVP) shortens a prolonged bleeding time (BT) in patients with uremia, congenital platelet dysfunction, and von Willebrand disease. To establish the limits of the clinical usefulness of DDAVP, a controlled randomized study was carried out in 53 patients and ten volunteers with different conditions that have in common a prolonged BT. DDAVP significantly shortened the BT in 21 cirrhotics (P less than .01), in eight patients with unclassified prolonged BT (P less than .05) and in ten volunteers taking the antiplatelet drugs aspirin (P less than .05) and ticlopidine. The BT changes were not statistically significant in 15 patients with severe thrombocytopenia nor in nine with congenital platelet dysfunction, even though a few patients with storage pool deficiency responded with a marked BT shortening. Our findings indicate that DDAVP might be given when biopsies or other surgical procedures must be carried out in patients with prolonged BT. However, the compound is often ineffective in patients with thrombocytopenia or congenital platelet dysfunction.
Assuntos
Tempo de Sangramento , Desamino Arginina Vasopressina/uso terapêutico , Cirrose Hepática/sangue , Testes de Função Plaquetária , Adolescente , Adulto , Idoso , Aspirina/farmacologia , Ensaios Clínicos como Assunto , Feminino , Humanos , Cirrose Hepática/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Distribuição Aleatória , Tiofenos/farmacologia , Trombocitopenia/sangue , Ticlopidina , Fator de von Willebrand/análiseRESUMO
Hematocrit (Ht), red cell deformability (RCD) determined using a filtration method and bleeding time (BT) have been studied in 28 patients with severe chronic liver disease. Our results show a decrease of Ht (p less than 0.001), RCD (p less than 0.05) and a prolongation of BT (p less than 0.001) not related to the platelet count. Moreover, inverse relationships between Ht and BT (r = -0.52; p less than 0.01) and between RCD and BT (r = -0.54; p less than 0.01) have been found. We conclude that hemorheological alterations, such as decreased Ht and RCD, play an important role in primary hemostasis of patients with chronic liver disease.
