From the Guidelines
For patients experiencing bleeding while on antiplatelet therapy, the recommended dose of DDAVP (Desmopressin) is typically 0.3 μg/kg intravenously, administered as a single dose, as suggested by the most recent guidelines 1. This dose can help stimulate the release of von Willebrand factor and factor VIII from endothelial cells, which is crucial for improving platelet adhesion and aggregation, thereby counteracting the effects of antiplatelet medications. The administration of DDAVP should be done with caution, considering its potential side effects, including hypotension, hyponatremia, fluid retention, and facial flushing, as noted in previous studies 1. Key points to consider when administering DDAVP include:
- Infusing the medication over 15-30 minutes
- Monitoring for potential side effects
- Restricting fluid intake during treatment to reduce the risk of hyponatremia
- Considering the risk of tachyphylaxis with repeated dosing, especially in severe cases where a repeat dose may be necessary after 12-24 hours. It's also important to note that while DDAVP may be beneficial in certain cases of bleeding associated with antiplatelet therapy, its efficacy and safety, particularly with the most recent antiplatelet agents, are still under evaluation, and its use should be guided by the most current clinical evidence and guidelines 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Hemophilia A and von Willebrand’s Disease (Type I): Desmopressin acetate injection 4 mcg/mL is administered as an intravenous infusion at a dose of 0. 3 mcg desmopressin acetate/kg body weight diluted in sterile physiological saline and infused slowly over 15 to 30 minutes.
The recommended dose of DDAVP (Desmopressin) for a patient experiencing bleeding while on antiplatelet therapy is 0.3 mcg desmopressin acetate/kg body weight.
- This dose is administered as an intravenous infusion, diluted in sterile physiological saline, and infused slowly over 15 to 30 minutes.
- The necessity for repeat administration of desmopressin acetate injection or use of any blood products for hemostasis should be determined by laboratory response as well as the clinical condition of the patient 2.
From the Research
DDAVP Dose for Bleeding with Antiplatelet Therapy
The recommended dose of DDAVP (Desmopressin) for a patient experiencing bleeding while on antiplatelet therapy is:
- 0.3 micrograms/kg given intravenously, as stated in the study 3
- This dose has been shown to achieve optimal hemostatic effect, with increases in plasma concentrations of coagulation factor VIII, von Willebrand factor, and tissue plasminogen activator, as well as increases in platelet adhesiveness 3
Administration Routes
DDAVP can be administered through:
- Intravenous injection
- Subcutaneous injection
- Intranasal spray, which has been shown to be efficient for home treatment of patients with bleeding disorders 3
Effects on Platelet Function
DDAVP has been shown to:
- Shorten bleeding time in patients with disorders of platelet function 4
- Interact directly with platelets and facilitate their activation via other agonists 4
- Increase platelet aggregation stimulated by ADP and collagen in patients with von Willebrand's disease, hemophilia A, and other platelet dysfunction disorders 4
Clinical Relevance
The use of DDAVP in patients with bleeding disorders, including those on antiplatelet therapy, has been studied in several clinical trials:
- A study published in 1995 found that DDAVP increased factor VIII:C levels in a subgroup of patients with autosomal recessive severe von Willebrand disease 5
- Another study published in 1990 found that DDAVP increased von Willebrand factor antigen levels, but did not alter platelet aggregation, bleeding time, or blood loss in patients undergoing cardiac surgery with extracorporeal circulation 6
- A double-blind placebo-controlled trial published in 1995 found that DDAVP shortened bleeding time and raised plasma FVIIIC and von Willebrand factor in patients with congenital platelet defects 7