From the Guidelines
Desmopressin (DDAVP) does not have a significant association with an increased risk of myocardial infarction or cerebrovascular accident, based on the most recent and highest quality evidence available. The primary concern with desmopressin is its potential to cause hyponatremia due to water retention, which can lead to seizures, heart problems, and stroke in severe cases 1. However, this risk is generally considered low, and serious side effects have been reported in only a few cases, often with contributing factors such as excessive water intake or underlying medical conditions 1.
Key Considerations
- Desmopressin's effects on fluid balance and blood sodium levels are the primary concerns for potential cardiovascular risks 1.
- Patients at higher risk of complications include the elderly, those with pre-existing cardiovascular disease, patients with kidney problems, and individuals taking other medications that affect fluid balance.
- To minimize risks, it is recommended to start with the lowest effective dose, monitor fluid intake and urine output, and have regular blood tests to check sodium levels 1.
- Patients should be alert for symptoms of hyponatremia, such as headache, nausea, and confusion, and inform their doctor immediately if they experience chest pain, shortness of breath, or neurological symptoms while taking desmopressin.
Evidence Review
The most recent study available, from 2024, does not provide direct evidence on the risk of myocardial infarction or cerebrovascular accident associated with desmopressin 1. However, an earlier study from 2004 provides more relevant information on the safety profile of desmopressin, including its potential to cause hyponatremia and other side effects 1.
Clinical Implications
In clinical practice, the benefits of desmopressin treatment should be weighed against the potential risks for each individual patient. While the risk of myocardial infarction or cerebrovascular accident is not significantly increased, patients should be monitored for signs of hyponatremia and other potential side effects, and the lowest effective dose should be used to minimize risks.
From the FDA Drug Label
Post Marketing There have been rare reports of thrombotic events (acute cerebrovascular thrombosis, acute myocardial infarction) following desmopressin acetate injection in patients predisposed to thrombus formation The following adverse reactions have been identified during post-approval use of desmopressin acetate... Cardiovascular: ... thrombotic events
Desmopressin (DDAVP) may increase the risk of myocardial infarction or cerebrovascular accident, particularly in patients predisposed to thrombus formation 2, 3.
- Key points:
- Rare reports of thrombotic events, including acute cerebrovascular thrombosis and acute myocardial infarction, have been associated with desmopressin acetate injection.
- Patients with conditions that increase the risk of thrombus formation may be at higher risk.
- Monitoring and caution are advised when using desmopressin acetate in these patients.
From the Research
Desmopressin and Cardiovascular Risk
- The relationship between desmopressin (DDAVP) and the risk of myocardial infarction or cerebrovascular accident is not directly addressed in the provided studies.
- However, studies have investigated the effects of desmopressin on blood pressure, heart rate, and other cardiovascular parameters:
- A study on postural tachycardia syndrome found that desmopressin decreased tachycardia and improved symptoms 4.
- Another study on patients with bleeding disorders found that desmopressin was generally well-tolerated, with temporary and non-clinically relevant changes in water balance parameters and vital signs 5.
- A study on essential hypertension found that desmopressin caused a fall in blood pressure, an increase in heart rate, and a rise in plasma renin and noradrenaline 6.
- The effects of blood pressure lowering on the risk of myocardial infarction and stroke have been investigated in other studies:
- A review of blood pressure targets for the treatment of people with hypertension and cardiovascular disease found that there is probably little to no difference in total mortality and cardiovascular mortality between people treated to a lower compared to a standard blood pressure target 7.
- A study on the prevention of myocardial infarction and stroke found that lowering blood pressure by 5 mmHg diastolic reduces the risk of stroke by an estimated 34% and ischaemic heart disease by 21% from any pre-treatment level 8.
- Overall, while the provided studies do not directly address the risk of myocardial infarction or cerebrovascular accident associated with desmopressin, they suggest that desmopressin may have beneficial effects on cardiovascular parameters in certain contexts, and that blood pressure lowering can be an effective strategy for preventing cardiovascular events 7, 5, 4, 8, 6.