deamino-arginine-vasopressin and Liver-Diseases

The complex nature of haemostasis in patients with liver disease can result in bleeding and/or thrombosis. These opposing outcomes, which have multiple contributing factors, can pose diagnostic and therapeutic dilemmas for physicians. With the high rate of haemorrhagic complications in patients with cirrhosis, we examine the various procoagulants available for use in this population. In this Review, we describe the clinical and current rationale for using each of the currently available procoagulants-vitamin K, fresh frozen plasma (FFP), cryoprecipitate, platelets, recombinant factor VIIa (rFVIIa), antifibrinolytics, prothrombin concentrate complexes (PCC), desmopressin and red blood cells. By examining the evidence and use of these agents in liver disease, we provide a framework for targeted, goal-directed therapy with procoagulants.

Topics: Antifibrinolytic Agents; Coagulants; Deamino Arginine Vasopressin; Erythrocyte Transfusion; Factor VIIa; Factor VIII; Fibrinogen; Hemorrhage; Humans; Liver Diseases; Plasma; Recombinant Proteins; Vitamin K

Topics: Animals; Blood Loss, Surgical; Deamino Arginine Vasopressin; Factor VIII; Female; Hemophilia A; Hemorrhage; Hemorrhagic Disorders; History, 18th Century; History, 20th Century; Humans; Italy; Kidney Diseases; Liver Diseases; Male; Platelet Adhesiveness; Rabbits; von Willebrand Diseases; von Willebrand Factor

To evaluate the hemostatic effects of desmopressin (DDAVP) in dogs with aspirin-induced platelet dysfunction and hemostatic impairment in chronic liver diseases, 3 microg/kg DDAVP was administrated subcutaneously. In aspirin-induced platelet dysfunction dogs (n=5), prolonged BMBT (buccal mucosal bleeding time) was shortened significantly after DDAVP injection (2.2 +/- 1.2 min, P<0.05). In dogs with chronic liver diseases (n=4), activated partial thromboplastin time (APTT) tended to shorten by 0.9 to 3.0 sec, and prolonged BMBT was shortened in two cases for 4.2 and 1.7 min after DDAVP injection. Therefore, the present results indicated that DDAVP shortened the prolonged BMBT in dogs with aspirin-induced platelet dysfunction and chronic liver disease. DDAVP might be helpful in hemostasis under invasive procedures such as biopsy or surgery for dogs with hemostatic impairment.

Topics: Animals; Aspirin; Blood Coagulation; Blood Platelet Disorders; Blood Platelets; Deamino Arginine Vasopressin; Dog Diseases; Dogs; Factor VIII; Hemostasis; Injections, Subcutaneous; Liver Diseases

Liver disease results in complex alterations of all 3 phases of hemostasis. It is now recognized that hemostasis is rebalanced in chronic liver disease. The fall in clotting factor levels is accompanied by a parallel fall in anticoagulant proteins. High von Willebrand factor levels counteract defects in primary hemostasis. Conventional coagulation tests do not fully reflect the derangement in hemostasis and do not accurately predict the risk of bleeding. Global coagulation assays (thrombin generation, thromboelastography) reflect the interaction between procoagulant factors, anticoagulant factors, platelets, and the fibrinolytic system and show promise for assessing bleeding risk and guiding therapy. These assays are not yet commercially approved or validated. Prevention of bleeding should not be aimed at correcting conventional coagulation tests. Thrombopoietin receptor agonists were shown to increase the platelet count in cirrhotic patients undergoing invasive procedures but may increase the risk of thrombosis. Rebalanced hemostasis in liver disease is precarious and may be tipped toward hemorrhage or thrombosis depending on coexisting circumstantial risk factors. Bacterial infection may impair hemostasis in cirrhosis by triggering the release of endogenous heparinoids. There are no evidence-based guidelines for hemostatic therapy of acute hemorrhage in liver disease. There is currently inadequate evidence to support the use of recombinant FVIIa, prothrombin complex concentrates, or tranexamic acid in acute variceal or other hemorrhage.

Topics: ADAM Proteins; ADAMTS13 Protein; Antifibrinolytic Agents; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Factors; Deamino Arginine Vasopressin; Factor VIIa; Fibrinolysis; Hemorrhage; Hemostasis; Humans; International Normalized Ratio; Liver Diseases; Plasma; Prothrombin Time; Receptors, Thrombopoietin; Recombinant Proteins; Risk Factors; Thrombelastography; Thrombin; Vitamin K

Diabetes insipidus in pregnancy has different causes. The association of diabetes insipidus with disturbances of liver function has been reported, however, diabetes insipidus has rarely been reported in HELLP syndrome. We present a 23-year-old primigravida with a singleton gestation complicated by HELLP syndrome who developed postpartum diabetes insipidus. Labor was induced promptly to terminate pregnancy because of intrauterine fetal death and liver dysfunction. 1-deamino-8-D-arginine-vasopressin was administered. Diabetes insipidus and liver dysfunction resolved within 2 weeks. Development of diabetes insipidus may result from increased vasopressinase activity mainly caused by deterioration of liver functions caused by HELLP syndrome. In pregnant women with liver disease as a result of any cause, the development of diabetes insipidus should be assessed with particular attention.

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Fetal Death; Glucocorticoids; HELLP Syndrome; Humans; Liver Diseases; Plasma Exchange; Postpartum Period; Pregnancy

Plasma levels of tissue plasminogen activator (t-PA) antigen, plasminogen activator inhibitor 1 (PAI-1) antigen and t-PA/PAI-1 complex were measured in plasmas from 18 healthy subjects and 75 patients with various diseases (28 patients with haematological malignancies, 20 with thrombotic diseases, five with infectious diseases, four with liver diseases, ten with bleeding disorders and eight miscellaneous conditions). In addition, we studied ten patients with bleeding disorders after DDAVP infusion and 18 healthy subjects after venous occlusion. Plasma levels of t-PA antigen, PAI-1 antigen and t-PA/PAI-1 complex were increased in the patients compared with the healthy subjects. t-PA/PAI-1 complex levels correlated well with t-PA antigen levels and molar concentrations of t-PA antigen were similar to those of the t-PA/PAI-1 complex. Venous occlusion induced an increase in both t-PA antigen and PAI-1 antigen and the molar concentration of the t-PA/PAI-1 complex was equivalent to that of t-PA antigen. Following DDAVP infusion, the levels of t-PA antigen and t-PA/PAI-1 complex increased but PAI-1 antigen levels decreased, and the increase of t-PA antigen was greater than that of t-PA/PAI-1 complex. These findings indicate that PAI-1 antigen exceeds t-PA antigen in healthy subjects and in patients with various diseases. We conclude that part of the t-PA/PAI-1 complex is rapidly cleared from the circulation and that free t-PA increases after DDAVP infusion.

Topics: Adult; Deamino Arginine Vasopressin; Fibrinolysis; Hematologic Diseases; Humans; Infections; Liver Diseases; Male; Plasminogen Activator Inhibitor 1; Pressure; Reference Values; Tissue Plasminogen Activator; Veins

Factor VIII amidolytic activity was measured by a commercially available method and compared with clotting activity measured in a one-stage assay. Parallel assays with both methods were used for plasma samples from 40 blood donors with normal or high Factor VIII levels, 22 patients with hemophilia before or after treatment with Factor VIII concentrates, 10 patients with chronic liver disease, and 10 normal subjects with high Factor VIII levels after treatment with desmopressin. The results obtained with the amidolytic assay were highly correlated (r = 0.97) with those obtained in the one-stage clotting assay. There were no significant differences in the results with the two methods in any of the patient groups, although in two cases of mild hemophilia the amidolytic assay gave lower values than the clotting assay. The reproducibility of the amidolytic assay (coefficient of variation = 6%) was better than that of the clotting assay (12%) at both normal and low levels of Factor VIII.

Topics: Adult; Amides; Blood Coagulation Tests; Deamino Arginine Vasopressin; Factor VIII; Female; Hemophilia A; Humans; Liver Diseases; Male; Middle Aged

Topics: Aldosterone; Arginine Vasopressin; Body Fluids; Deamino Arginine Vasopressin; Humans; Liver Diseases; Vasopressins

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Liver Diseases; Minerals; Vasopressins; Water