Desmopressin (DDAVP) in the management of patients with congenital bleeding disorders

Abstract

Bleeding disorders, including haemophilia, von Willebrand disease, and platelet function abnormalities pose a substantial, ongoing management challenge. Patients with these disorders not only require treatment during bleeding events but also need effective management strategies to prepare for events ranging from minor dental procedures to major surgery and childbirth. Moreover, women with bleeding disorders often require ongoing treatment to prevent menorrhagia during childbearing years. Desmopressin (DDAVP), a synthetic derivative of the antidiuretic hormone l-arginine vasopressin, has become a well-established tool for the management of patients with bleeding disorders in a variety of clinical settings. However, despite the widespread use of DDAVP, the available clinical evidence on its efficacy and safety in these settings is limited, and there has not been a recent comprehensive review of its role in the clinical management of patients with bleeding disorders. As such, this article provides a review of the mechanism of action and pharmacokinetic properties of DDAVP, followed by a concise summary of the available evidence for its use in the treatment and prevention of bleeding.

Desmopressin for treatment of platelet dysfunction and reversal of antiplatelet agents: a systematic review and meta‐analysis of randomized controlled trials

“…Patients treated with desmopressin had an increased risk of clinically significant hypotension, which is consistent with the results of other reviews . This adverse event may be more common when desmopressin is administered rapidly , but it is unclear whether transient hypotension has more severe outcomes, although no other imbalances of risks were seen across all trials. Other adverse events such as facial flushing, hyponatremia and seizures were not reported.…”

Differences in bleeding phenotype and provider interventions in postmenarchal adolescents when compared to adult women with bleeding disorders and heavy menstrual bleeding

“…12,13 The choice of therapy may be dictated by the patient’s age, menstrual cycle characteristics, patient’s acceptance of medication, side effect profile, the need for contraception and the family’s cultural values and preferences. Desmopressin, a good choice in VWD as well as minor PFD, 14 was more commonly utilized by the adolescents in our study, likely because of the ease of intranasal administration, intake limited to days of menstrual bleeding, to avoid hormonal agents due to its side effect profile/need for continued use and/or parental preference of non-contraceptive therapy. Adults utilized desmopressin less and likely opted for other treatment modalities such as hormonal therapy and surgical interventions, in part due to contraceptive benefits from hormonal therapy, and preference for definitive outcome with surgical interventions.…”

Bloodless Orthotopic Heart Transplantation in a Jehovah’s Witness

“…A 20-μg dose of desmopressin acetate was administered to increase the plasma levels of both von Willebrand factor and factor VIII. 3 The autologous harvested blood was returned to the patient in reverse order of collection and increased her Hgb by 4 g/dL ( Fig. 1).…”