From the Guidelines
DDAVP (desmopressin) is not recommended for aspirin reversal due to its uncertain efficacy and potential safety concerns. Aspirin irreversibly inhibits platelet function, and DDAVP does not counteract this mechanism effectively 1. The use of desmopressin for aspirin reversal is not supported by strong clinical evidence, with studies showing mixed results and significant limitations 1.
Key Points to Consider
- DDAVP works primarily by releasing von Willebrand factor and factor VIII, which improves platelet adhesion in certain conditions like von Willebrand disease or uremia, but does not adequately address aspirin's specific inhibition of cyclooxygenase 1.
- For urgent aspirin reversal, such as before emergency surgery or in cases of significant bleeding, platelet transfusion is the preferred approach, with a typical dose of 1 unit of platelets per 10kg body weight 1.
- If platelet transfusion is unavailable or contraindicated, other hemostatic agents like tranexamic acid might be considered as adjunctive therapy 1.
- The irreversible nature of aspirin's effect means that only new, unexposed platelets (via transfusion) can restore normal platelet function 1.
- For elective procedures, simply discontinuing aspirin 5-7 days before surgery is usually sufficient to allow natural replacement of affected platelets 1.
Safety Concerns
- Desmopressin can exert a systemic vasodilator effect, inducing arterial hypotension, reactive tachycardia, and facial flush 1.
- It also exposes patients to oliguria, hypervolemia, and hyponatremia, and rare cases of thromboembolic events have been reported 1.
From the Research
DDVAP for Aspirin Reversal
- Desmopressin (DDAVP) has been used to treat excessive bleeding associated with aspirin antiplatelet therapy 2.
- The anti-hemostatic effect of aspirin and other anti-platelet strategies can be corrected by the administration of platelet concentrate or desmopressin, if needed 3, 4.
- A systematic review and meta-analysis of randomized controlled trials found that desmopressin reduced red cell transfusions, blood loss, and risk of re-operation due to bleeding in patients with platelet dysfunction, including those caused by antiplatelet agents 5.
- The use of DDAVP in aspirin-related bleeding after cardiopulmonary bypass has been reported, with bleeding ceasing promptly after administration of DDAVP in all cases 2.
- However, an incremental administration of aspirin has also been shown to shorten the bleeding time prolonged by low-dose aspirin, which might be useful to control excessive bleeding during surgery in patients taking daily low-dosage aspirin as anti-coagulants 6.