Preoperative Desmopressin for Bleeding Reduction During Rhinoplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Gutierrez RWH, Gobbo HR, Fujimura Júnior AY, Heringer LDFL.

PubMed 40456991 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling four randomised trials with 262 patients, intranasal desmopressin before rhinoplasty cut blood loss by a mean of 15.22 mL and improved the surgical field, a statistically clear but clinically small effect.

Overview

Desmopressin boosts clotting factors and is being tested to reduce bleeding in rhinoplasty. The Brazilian authors pooled randomised trials of preoperative desmopressin, with intraoperative bleeding and surgical field quality as outcomes.

Sections of note

Four RCTs, 262 patients.
Total blood loss reduced by 15.22 mL (95% CI -19.52 to -10.93; p < 0.00001).
Heterogeneity 0%, meaning the trials agreed closely.
Independent analyses reported better surgical field quality.
The authors state clinical significance "remains to be established." Level of Evidence I.

What it means for a patient

About 15 mL (three teaspoons) less blood loss is consistent across trials but unlikely to be noticed by the patient.
A drier field may help the surgeon see and work more precisely.
Desmopressin has its own precautions (fluid retention, low sodium) that the anaesthetist weighs.

Why this paper matters

It gives a precise pooled estimate that keeps the benefit of desmopressin in proportion. Limits: four small trials, no bruising or outcome data pooled.

Terms

Desmopressin (DDAVP): a synthetic hormone that raises clotting factor levels.
Mean difference (MD): the pooled average difference between groups.
Randomised controlled trial (RCT): patients assigned by chance to treatment or control.
Intranasal: given as a spray or drops into the nose.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Bleeding is a primary complication associated with rhinoplasty. The hemostatic effect of Desmopressin (DDAVP) in enhancing coagulation factors is being studied to prevent this complication in rhinoplasty patients.

Methods: We performed a systematic review and meta-analysis of randomized clinical trials (RCTs) analyzing the effects of preoperative DDAVP during rhinoplasty. The outcomes evaluated were intraoperative bleeding and the quality of the surgical field.

Results: Four studies comprising 262 rhinoplasty patients were included. Preoperative administration of intranasal DDAVP was associated with a significant reduction in total blood loss (MD = - 15.22 mL; 95% CI - 19.52 to - 10.93; p < 0.00001; I2 = 0%). Independent analyses also reported a significant improvement in the quality of the surgical field.

Conclusion: DDAVP resulted in a statistically significant reduction in bleeding and a drier surgical field. However, the clinical significance remains to be established and further studies are required.

Level Of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).