The effect of desmopressin on blood loss in patients with rheumatoid arthritis undergoing hip arthroplasty

Background: Blood loss is an important issue for patients with rheumatoid arthritis undergoing hip surgery. We hypothesised that intraoperative desmopressin treatment would result in a reduction in blood loss in rheumatoid patients undergoing total hip arthroplasty. Methods: Seventy‐five patients scheduled for elective total hip arthroplasty were randomised to three groups to receive 0.4 μg/kg desmopressin (D 0.4), 0.2 μg/kg desmopressin (D 0.2) or placebo intraoperatively in a double‐blind fashion. Blood transfusions were based on calculated safe allowable blood loss and haemoglobin measurements (trigger 90 g/l, 5.59 mmol/l). The primary endpoint was the total blood loss measured till the end of the fourth post‐operative day. Secondary endpoints included red cell transfusion requirements and haemoglobin. Results: Total blood loss during the study period was not significantly different between the groups (D 0.4 1829 ± 1068; D 0.2 2240 ± 843 and placebo 2254 ± 1040 ml; P= 0.50). The total amount of red cell transfusions was fewer in group D 0.4 (3.6 ± 1.6 U) when compared with D 0.2 (4.4 ± 1.7 U; P=0.009) and placebo (4.5 ± 2.0 U; P= 0.011) groups. Haemoglobin concentration was lower in the placebo group in the first (5.42 ± 1.16 vs. 5.98 ± 0.47 mmol/l; P=0.033) and the second (6.28 ± 0.66 vs. 6.69 ± 0.47 mmol/l; P=0.033) post‐operative mornings compared with group D 0.4. Conclusion: Despite a lack of difference in the primary outcome, total blood loss, intraoperative administration of 0.4 μg/kg desmopressin resulted in fewer total red cell transfusion requirements in rheumatoid patients undergoing total hip arthroplasty when compared with 0.2 μg/kg treatment and placebo.