AVP Hormone Treatment Stems Blood Loss in Trauma Patients

Penn Medicine researchers believe their findings show that administering AVP to trauma patients with severe bleeding could become standard practice in trauma care.

Dosing gunshot victims and other hemorrhaging trauma patients with the hormone arginine vasopressin cut the need for stabilizing blood products in half, clinical trials at Penn Medicine show.

The study, published in JAMA Surgery, treated 100 hemorrhagic shock patients with a low-dose AVP at the Penn Medicine trauma center between 2013 and 2017. The protein is produced in the hypothalamus, stored in the pituitary gland, and constricts blood vessels when it is secreted into the bloodstream when blood pressure is too low.

All but seven of the patients were males who were victims of gunshot or knife wounds. The researchers randomized 49 of the patients to receive AVP in an initial moderate dose plus a slow infusion—during the first 48 hours of care—and the other 51 to receive the placebo equivalent.

The researchers found that the patients treated with AVP for 48 hours ended up receiving an average of 1.4 liters of blood products – less than half the 2.9 liters that was the average amount given to patients treated with the placebo.

The AVP group also had a markedly lower rate (11% vs. 34%) of deep-vein thrombosis. Rates of complications within 30 days for the AVP and placebo groups were otherwise similar (55% vs. 64%), and the numbers of deaths in that period were the same (six in each group), the study said.

While the AVP group had shorter average stays in the hospital, the relatively small number of patients in the study meant that these length-of-stay differences were not statistically significant.

There are more than 100,00 firearm-related injuries resulting in more than 36,000 deaths annually in the United States. The Penn Medicine researchers believe their findings show that administering AVP to trauma patients with severe bleeding could become standard practice in trauma care, reducing the use of blood products and their adverse side effects.

"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," said Carrie A. Sims, MD, an associate professor of Surgery and Laboratory Director of the Penn Acute Research Collaboration, in comments accompanying the study.

"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," Sims said. "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."

(Support for the study was provided by the National Trauma Institute and the U.S. Department of the Army.)