From the Guidelines
DDAVP (desmopressin) does not significantly increase Factor XI levels. DDAVP primarily works by stimulating the release of von Willebrand factor (vWF) and Factor VIII from endothelial cell storage sites, but it has minimal to no effect on Factor XI levels 1. This medication is commonly used to treat or prevent bleeding in patients with mild hemophilia A, von Willebrand disease type 1, and certain platelet function disorders. The typical dosing for DDAVP is 0.3 mcg/kg intravenously or subcutaneously, or 150-300 mcg intranasally, with effects lasting approximately 8-12 hours. For patients with Factor XI deficiency specifically, fresh frozen plasma or Factor XI concentrates (where available) would be more appropriate treatment options to increase Factor XI levels, as seen in the use of prothrombin complex concentrates (PCCs) which can increase plasma factor X activity by 40-60 IU/dL 1. DDAVP works through V2 vasopressin receptors to trigger the release of pre-formed hemostatic factors, but since Factor XI is not stored in significant amounts in endothelial cells, DDAVP cannot mobilize what isn't there.
Some key points to consider when managing Factor XI deficiency include:
- The use of PCCs, which can provide factors II, IX, and X, but may vary in their composition and risk of thrombosis 1
- The importance of monitoring plasma factor X levels and adjusting treatment accordingly, particularly in patients with severe symptoms or those requiring frequent infusions 1
- The potential risks associated with PCC administration, including thrombosis and the accumulation of prothrombin (factor II) due to its long half-life 1
In terms of treatment options, fresh frozen plasma or Factor XI concentrates are preferred over DDAVP for increasing Factor XI levels, as they can provide a more direct and effective means of replacing the deficient factor. However, the choice of treatment will depend on the individual patient's needs and circumstances, and should be guided by evidence-based recommendations and expert consensus 1.
From the Research
Desmopressin (DDAVP) and Factor XI
- The effect of Desmopressin (DDAVP) on Factor XI levels has been studied in various research papers 2, 3, 4, 5, 6.
- According to a study published in the British journal of haematology in 2004, DDAVP did not produce a clinically significant increase in Factor XI coagulant activity (FXI:C) or Factor XI antigen (FXI:Ag) in patients with von Willebrand disease or mild hemophilia A 2.
- The study found that the mean FXI:C pre-DDAVP and at 1 h post-DDAVP was 90.7 (+/-22.9) U/dl and 92.1 (+/-20.9) U/dl, respectively, and the mean FXI:Ag at time 0 and 1 h was 92.2 (+/-20.1) U/dl and 89.9 (+/-21.3) U/dl, respectively 2.
- Other studies have focused on the use of DDAVP in patients with hemophilia A and von Willebrand disease, and its effects on Factor VIII and von Willebrand factor levels 3, 4, 5, 6.
- However, these studies do not provide evidence that DDAVP increases Factor XI levels 3, 4, 5, 6.
- In summary, the available evidence suggests that DDAVP does not have a clinically significant effect on Factor XI levels 2.