Published September 11, 2019 Hospital/Health System Less Blood Product Needed to Stabilize Patients Receiving Arginine Vasopressin By staff Philadelphia—A new study offers important and potentially life-saving information for hospital pharmacists.The report in JAMA Surgery suggests that trauma patients with severe blood loss need half the volume of blood products required to stabilize them if they receive the hormone arginine vasopressin (AVP).The first-of-its-kind clinical trial was conducted by Penn Medicine and has special importance for the treatment of patients with gun-related injuries, according to the authors.“Unintentional traumatic injuries are the leading cause of death in the United States for people younger than 45, and the injuries often involve severe blood loss,” explained Carrie A. Sims, MD, PhD, an associate professor of surgery and laboratory director of the Penn Acute Research Collaboration. “We can replace a patient’s lost blood with blood products such as packed red blood cells, fresh frozen plasma, and platelets, but use of these options can lead to serious complications and they may not fully replace key molecules in blood that are needed to support blood pressure and the normal function of vital organs. The results of this trial suggest a promising way to reduce the amount of blood needed to save the lives of patients with life-threatening injuries.”The report points out that severe hemorrhagic shock is associated with AVP deficiency. Researchers posited that supplementation of the hormone might decrease the need for blood products in resuscitation.To determine that, the study team conducted a randomized, double-blind placebo-controlled clinical trial including adult trauma patients (aged 18-65 years) who received at least 6 units (U) of any blood product within 12 hours of injury at a single urban level 1 trauma center from May 1, 2013, through May 31, 2017. Excluded from the study were patients who had prehospital cardiopulmonary resuscitation, emergency department thoracotomy, corticosteroid use, chronic renal insufficiency, coronary artery disease, traumatic brain injury requiring any neurosurgical intervention, pregnancy, prisoner status, or AVP administration before enrollment. For the study, after administration of an AVP bolus (4 U) or placebo, participants received AVP (≤0.04 U/min) or placebo for 48 hours to maintain a mean arterial blood pressure of at least 65 mmHg. Defined as the primary outcome was total volume of blood product transfused, while secondary end points included total volume of crystalloid transfused, vasopressor requirements, secondary complications, and 30-day mortality.Overall, 100 patients—primarily young, median age 27 years, and mostly male with penetrating trauma—underwent randomization (49 to the AVP group and 51 to the placebo group). Results indicated that, at 48 hours, patients who received AVP required significantly less blood products (median, 1.4 [interquartile range (IQR), 0.5-2.6] vs. 2.9 [IQR, 1.1-4.8] L; P = .01) but did not differ in requirements for crystalloids (median, 9.9 [IQR, 7.9-13.0] vs. 11.0 [8.9-15.0] L; P = .22) or vasopressors (median, 400 [IQR, 0-5900] vs. 1400 [IQR, 200-7,600] equivalent units; P = .22). While mortality rates didn’t differ (6 of 49 [12%] vs. 6 of 51 [12%]; P = .94) and total complications were similar (24 of 44 [55%] vs. 30 of 47 [64%]; P = .37), the AVP group had less deep venous thrombosis (5 of 44 [11%] vs. 16 of 47 [34%]; P = .02), researchers note.“In this randomized clinical trial of 100 adult trauma patients in hemorrhagic shock, arginine vasopressin supplementation significantly decreased the volume of blood products given in the first 48 hours by a median of 1.4 L without increasing complications,” the authors conclude, adding that additional research should focus on whether AVP improves morbidity or mortality. « Click here to return to Weekly News Update.