2020, Number 2
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Rev Cubana Hematol Inmunol Hemoter 2020; 36 (2)
Response to the desmopressin test: cohort study in a Bogota hospital
Solano-Trujillo MH, Casas-Patarroyo CP, Espinosa-Redondo DL, Abello-Polo V, Parra L, Palacios A
Language: Spanish
References: 15
Page: 1-15
PDF size: 345.75 Kb.
ABSTRACT
Introduction:
Desmopressin is a synthetic analog for vasopressin that increases the plasma levels of factor VIII and of von Willebrand factor. Some authors indicate maintenance time of hemostatic effect between 6 and 8 hours, so it is necessary to study its effect over time.
Objective:
To determine the variation of laboratory variables in patients with von Willebrand disease and type A hemophilia after desmopressin administration.
Methods:
Retrospective cohort study carried out in a university hospital in Bogotá. Nonrandomized sampling was used, including 24 patients older than 18 years and with a diagnosis of von Willebrand disease (67%) and non-severe type A hemophilia (33%), who underwent the desmopressin test. Two groups of patients were created, regardless of diagnosis: 15 patients with baseline values of factor-VIII lower than 50 IU and 13 patients with baseline values of von Willebrand antigen lower than 50 IU. Descriptive and correlational statistical analysis was performed in Stata 13.
Results:
87% of patients in group I reached the therapeutic value two hours after desmopressin administration (p=0.000), which was maintained for up to six hours in 77% (p=0.000). In group II, 92% achieved the therapeutic value in two hours (p=0.003), which continued until six hours in 83% (p=0.000).
Conclusions:
Response to desmopressin administration was maximum at two hours, when it began to decrease progressively, but maintained the therapeutic effect. Although no adverse effects were found, there is variability of response among patients.
REFERENCES
Leal R, Alberca I, Asuero MS, Bóveda JL, Carpio N, Contreras E, et al. Documento "Sevilla" de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Med Clin (Barc). 2006;127(Supl 1):3-20.
Franchinia M, Mannucci PM. Von Willebrand factor (Vonvendi(r)): the first recombinant product licensed for the treatment of von Willebrand disease. Expert Rev Hematol. 2016 Sep;9(9):825-30. doi: 10.1080/17474086.2016.1214070.
Özgönenel B, Rajpurkar M, Lusher JM. How do you treat bleeding disorders with desmopressin? Postgrad Med J. 2007;83:159-63. doi: 10.1136/pgmj.2006.052118
Stoof SCM, Schütte LM, Leebeek FWG, Cnossen MH, Kruip MJHA. Desmopressin in haemophilia: The need for a standardised clinical response and individualised test regimen. Haemophilia. 2017 Nov;23(6):861-7. doi: 10.1111/hae.13295.
Iorio A, Remmington T, Jahnke N, Dwan K, Hall N. Desmopressin acetate (DDAVP) for preventing and treating bleeding in people with mild or moderate haemophilia A. Cochrane Database Systematic Reviews. 2015;12:CD011985. DOI: 10.1002/14651858.CD011985.
Schütte LM, van Hest RM, Stoof SCM, Leebeek FWG, Cnossen MH, Kruip MJHA, et al. Pharmacokinetic Modelling to Predict FVIII:C Response to Desmopressin and Its Reproducibility in Non severe Haemophilia A Patients. Thromb Haemost. 2018 Apr;118(4):621-9. doi: 10.1160/TH17-06-0390.
Leissinger C, Carcao M, Gill JC, Journeycake J, Singleton T, Valentino L. Desmopressin (DDAVP) in the management of patients with congenital bleeding disorders. Haemophilia. 2014 Mar;20(2):158-67. doi: 10.1111/hae.12254.
Franchini M. The use of desmopressin as a hemostatic agent: A concise review. Am. J. Hematol. 2007;82(8):731-5.
Mannucci PM. La desmopresina (DDAVP) en el tratamiento de los trastornos de la coagulación. Edición revisada. Canadá: Federación Mundial de Hemofilia; 2012. p. 12
Hews-Girard J, Rydz N, Lee A, Goodyear MD, Poon MC. Desmopressin in non-severe haemophilia A: Test-response and clinical outcomes in a single Canadian centre review. Haemophilia. 2018 Sep; 24(5):720-5. doi: 10.1111/hae.13586.
Besser MW, Ortmann E, Klein AA. Haemostatic management of cardiac surgical haemorrhage. Anaesthesia 2015 Jan;70(Suppl 1):87-95, e29-31. doi: 10.1111/anae.12898.
Stoof SC, Cnossen MH, de Maat MP, Leebeek FW, Kruip MJ. Side effects of desmopressin in patients with bleeding disorders. Haemophilia. 2016 Jan;22(1):39-45. doi: 10.1111/hae.12732.
Castaman G, Tosetto A, Federici AB, Rodeghiero F. Bleeding tendency and efficacy of anti-haemorrhagic treatments in patients with type 1 von Willebrand disease and increased von Willebrand factor clearance. Thromb Haemost. 2011;105(4):647-54. doi: 10.1160/TH10-11-0697.
Juul KV, Klein BM, Sandström R, Erichsen L, Nørgaard JP. Gender difference in antidiuretic response to desmopressin. Am J Physiol Renal Physiol. 2010; 300(5):F1116-22. doi: 10.1152/ajprenal.00741.2010.
Abed H, Ainousa A. Dental management of patients with inherited bleeding disorders: a multidisciplinary approach. Gen Dent. 2017 Nov-Dec;65(6):56-60.