From the Research
For patients with uremic bleeding and a creatinine clearance (CrCl) <50 mL/min, conjugated estrogens are a recommended alternative to DDAVP (desmopressin), as they can be administered at 0.6 mg/kg IV daily for 5 days, with effects lasting up to 2 weeks, as supported by the study published in The New England Journal of Medicine 1.
Alternatives to DDAVP
Other alternatives to DDAVP include:
- Tranexamic acid, which can be used at a reduced dose of 10 mg/kg IV or PO every 12-24 hours (adjusted for renal function) 2
- Hemodialysis, which can improve uremic bleeding by removing uremic toxins that contribute to platelet dysfunction 2
- Cryoprecipitate, which may be used for acute bleeding at 10 units for immediate but short-term hemostasis 3
- Erythropoietin-stimulating agents, which can help long-term by improving anemia and reducing bleeding tendency, typically dosed at 50-100 units/kg three times weekly 4
Mechanism of Action
These alternatives work through different mechanisms:
- Conjugated estrogens enhance platelet adhesion and increase von Willebrand factor levels 1
- Tranexamic acid inhibits fibrinolysis 2
- Hemodialysis addresses the underlying uremia 2
Important Considerations
Dose adjustments are crucial for all pharmacological options due to the reduced renal clearance, and patients should be monitored for thrombotic complications, particularly with tranexamic acid 4. Additionally, the study published in Annals of Hematology 5 suggests that desmopressin can improve platelet function in uremic patients taking antiplatelet agents who require emergent invasive procedures, but this may not be a suitable alternative for patients with impaired renal function.