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CRITICAL CARE AND TRAUMA

Does Arginine Vasopressin Influence the Coagulation System in Advanced Vasodilatory Shock with Severe Multiorgan Dysfunction Syndrome?

Martin W. Dünser, MD^*, Dietmar R. Fries, MD^*, Wolfgang Schobersberger, MD^*, Hanno Ulmer, PhD, Volker Wenzel, MD^*, Barbara Friesenecker, MD^*, Walter R. Hasibeder, MD^*, and Andreas J. Mayr, MD^*

*Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, and the Institute of Medical Biostatistics, The University of Innsbruck, Innsbruck, Austria

Address correspondence and reprint requests to Andreas J. Mayr, MD, Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, The University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Address email to Andreas.J.Mayr{at}uibk.ac.at

Arginine vasopressin (AVP) is a potent supplementary vasopressor in advanced vasodilatory shock, but decreases in platelet count have been reported during AVP therapy. In this study we evaluated the effects of AVP infusion on the coagulation system in advanced vasodilatory shock when compared to norepinephrine (NE) infusion alone. Forty-two patients with advanced vasodilatory shock (NE requirements >0.5 µg · kg^–1 · min^–1, mean arterial blood pressure <70 mm Hg) were prospectively randomized to receive an additional AVP infusion (4 U/h) or NE infusion alone. Most patients received coagulation active treatment (fresh-frozen plasma, thrombocyte concentrates, coagulation factors, and continuous veno-venous hemofiltration with heparin). At baseline and 1, 24, and 48 h after randomization, coagulation laboratory variables and a modified thrombelastography were measured. There were no differences between groups in plasmatic coagulation variables. Although there was no significant difference between groups, platelet count significantly decreased in AVP patients (P = 0.036). There were no differences in results of modified thrombelastography analyses between groups. AVP infusion in advanced vasodilatory shock with severe multiorgan dysfunction syndrome does not increase plasma concentrations of Factor VIII, von Willebrand Factor antigen, and ristocetin Co-Factor but may stimulate platelet aggregation and induce thrombocytopenia. Global coagulation, assessed by modified thrombelastography, is not different from patients receiving NE infusion alone.

IMPLICATIONS: This randomized, controlled study examined the effects of arginine vasopressin (AVP) infusion on the coagulation system in advanced vasodilatory shock with severe multiorgan dysfunction syndrome. AVP does not increase Factor VIII, von Willebrand Factor antigen, and ristocetin Co-Factor but may induce thrombocytopenia. Global coagulation is not different from norepinephrine therapy alone.

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