Evaluation of the clinical safety of desmopressin during pregnancy in women with a low plasmatic von Willebrand factor level and bleeding history

Sánchez‐Luceros, Analía; Meschengieser, Susana S.; Turdó, Karina; Arizó, Adriana; Woods, Adriana Inés; Casais, Patricia; Blanco, Alicia N.; Kempfer, Ana C.; Lazzari, M.A.

doi:10.1016/j.thromres.2006.09.004

Cited by 38 publications

(30 citation statements)

References 17 publications

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“…69 However, if responsive to DDAVP, women with levels only slightly above or around 50 IU/dL may receive a single dose of desmopressin at the beginning of labor, especially if epidural anesthesia is required. 69,70 DDAVP can also be safely used in the first trimester of pregnancy to cover invasive procedures, such as villocentesis and amniocentesis. 69 Additional measures include managing the delivery without using ventouse or forceps and administering antifibrinolytic agents orally in the first week of puerperium to prevent delayed postpartum bleeding.…”

Section: Treatment Of Type 2 Vwd: a Case-based Approachmentioning

confidence: 99%

How I treat type 2 variant forms of von Willebrand disease

Tosetto

Castaman²

2015

Blood

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Type 2 von Willebrand disease (VWD) includes a wide range of qualitative abnormalities of von Willebrand factor structure and function resulting in a variable bleeding tendency. According to the current classification, 4 different subtypes can be identified, each with distinctive phenotypic and therapeutic characteristics. Current available laboratory methods allow a straightforward approach to VWD subtyping, and although the precise molecular characterization remains complex, it is not required for appropriate treatment of the vast majority of cases. Desmopressin can be useful only in a few type 2 cases compared with patients with actual quantitative deficiency (type 1), most often in variants with a nearly normal multimeric pattern (type 2M). However, since no laboratory test accurately predicts response to desmopressin, a trial test should always be performed in all type 2 VWD patients, with the exception of type 2B ones. Replacement therapy with plasma-derived von Willebrand factor-factor VIII concentrates represents the safe mainstay of treatment of all patients, particularly those not responding to desmopressin or requiring a sustained hemostatic correction because of major surgery or bleeding. A significant patient bleeding history correlates with increased bleeding risk and should be considered in tailoring the optimal antihemorrhagic prophylaxis in the individual patient.

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Section: Treatment Of Type 2 Vwd: a Case-based Approachmentioning

confidence: 99%

How I treat type 2 variant forms of von Willebrand disease

Tosetto

Castaman²

2015

Blood

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“…Administration of DDAVP, combined with litres of fluids and oxytocin, may result in lifethreatening hyponatraemia [70]. A single dose of DDAVP immediately prior to epidural catheter placement in labour, however, has not been associated with adverse events [71].…”

Section: Management Of Pregnancy and Childbirthmentioning

confidence: 99%

Women and bleeding disorders

James

2010

Haemophilia

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Summary. While women are rarely affected by haemophilia, they are equally as likely as men to have other bleeding disorders. Menorrhagia, or heavy menstrual bleeding, is the most common symptom that they experience. Not only is menorrhagia more prevalent among women with bleeding disorders, but bleeding disorders are more prevalent among women with menorrhagia. Although menorrhagia is the most common reproductive tract manifestation of a bleeding disorder, it is not the only manifestation. Women with bleeding disorders appear to be at an increased risk of developing haemorrhagic ovarian cysts and possibly endometriosis. Women suspected of having a bleeding disorder or being a carrier of haemophilia should be offered diagnostic testing before getting pregnant to allow for appropriate preconception counselling and pregnancy management. During pregnancy, women with bleeding disorders may be at an increased risk of bleeding complications. At the time of childbirth, women with bleeding disorders appear to be more likely to experience postpartum haemorrhage, particularly delayed or secondary postpartum haemorrhage. As women with bleeding disorders grow older, they may be more likely to manifest gynaecological conditions which present with bleeding. Women with bleeding disorders are more likely to undergo a hysterectomy and are more likely to have the operation at a younger age. While women with bleeding disorders are at risk for the same obstetrical and gynaecological problems that affect all women, women with bleeding disorders are disproportionately affected by conditions that manifest with bleeding. Optimal management involves the combined expertise of haemostasis experts and obstetrician-gynaecologists.

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“…Recent experience, however, suggests the possibility of initiating treatment immediately before delivery, without evident side effects for the mother or the newborn. 61 Oral antifibrinolytic agents can be used during this period to prevent delayed postpartum bleeding. In type 3 VWD women, VWF and FVIII do not increase during pregnancy and thus VWF/FVIII concentrates may be required during pregnancy to control intermittent vaginal bleeding and at delivery or for Cesarean section.…”

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confidence: 99%