From the Guidelines
The correct answer is (c) desmopressin (DDAVP). Platelet dysfunction in uremia can be effectively corrected with desmopressin, which is a synthetic analog of vasopressin. In patients with uremia, platelets have impaired adhesion and aggregation despite normal platelet counts, leading to bleeding tendencies. DDAVP works by stimulating the release of von Willebrand factor and factor VIII from endothelial cells, which enhances platelet adhesion to damaged blood vessels. The typical dose is 0.3 mg/kg intravenously or 3 mg/kg intranasally, with effects lasting approximately 6-8 hours, as noted in the study by 1. DDAVP is particularly useful before invasive procedures or to manage acute bleeding episodes in uremic patients. Unlike the other options listed, DDAVP specifically addresses the functional platelet defect in uremia rather than simply replacing clotting factors. Some key points to consider when using DDAVP include:
- Administration via IV or subcutaneously at a dose of 0.3 mg/kg, or 3 mg/kg intranasally, as mentioned in the study by 1
- Hemostatic effect typically detected within 1 hour and lasts for 6–8 hours, as seen in the study by 1
- DDAVP may be appropriate for administration to patients with end-stage renal disease and uremic platelet dysfunction, according to the study by 1 Fresh-frozen plasma, cryoprecipitate, factor VIII concentrate, and vitamin K do not directly correct the platelet dysfunction mechanism that occurs in uremic patients.
From the Research
Platelet Dysfunction in Uremia
Correction Options
- Desmopressin (DDAVP) has been shown to improve platelet function in uremic patients by shortening collagen/epinephrine-closure time 2, 3 and increasing von Willebrand factor activities 3, 4
- The other options, such as fresh-frozen plasma, cryoprecipitate, factor VIII concentrate, and vitamin K, are not supported by the provided evidence as a correction for platelet dysfunction in uremia