Argipressin for prevention of blood loss in hepatic resection: a randomised, placebo-controlled, double-blind trial

AbstractBackground Blood loss and blood transfusion are associated with negative short-term and long-term outcomes in hepatic resection. Vasopressin decreases portal blood flow and could reduce bleeding during liver surgery. We compared the effects of argipressin and placebo on blood loss and blood transfusions in adult patients undergoing hepatic resection. Methods A single-centre, randomised, placebo-controlled, double-blind trial was conducted at Sahlgrenska University Hospital, Sweden. Adult male and female patients undergoing hepatic resection were randomised to infusion of argipressin 0.8 U ml−1 i.v. or placebo, at a rate of 0.056 ml kg−1 h−1 (i.e. 3.6 U h−1 for 80 kg) during surgery. The primary outcome was blood loss (ml) during surgery. Secondary outcomes included transfusion requirements and complications at postoperative day 30. Results The primary analysis included 245 participants. Baseline characteristics were similar between the groups. Median blood loss was 450 ml in the argipressin group (n=119) vs 500 ml in the placebo group (n=126) (adjusted relative risk 0.90, 95% confidence interval CI 0.70–1.17, P=0.44). Red blood cell transfusion occurred in 43 patients (36.8%) in the argipressin group and 52 patients (41.3%) in the placebo group (adjusted odds ratio aOR 0.84, 95% CI 0.48–1.49, P=0.56). Patients randomised to argipressin had fewer postoperative complications than those randomised to placebo (45 38.8% vs 72 58.1%; aOR 0.43, 95% CI 0.25–0.74, P=0.0025). Conclusions Perioperative treatment with argipressin did not reduce blood loss or transfusion requirements in hepatic resection. The incidence of postoperative complications appeared to be lower in the argipressin group. Clinical trial registration NCT05293041.