What is DDAVP (Desmopressin)?
DDAVP (desmopressin) is a synthetic analogue of the natural hormone arginine vasopressin that primarily increases von Willebrand factor and factor VIII levels, with applications in treating certain bleeding disorders, central diabetes insipidus, and potentially reducing bleeding in specific surgical settings. 1, 2
Pharmacology and Mechanism of Action
- Desmopressin is chemically defined as 1-(3-mercaptopropionic acid)-8-D-arginine vasopressin monoacetate (salt) trihydrate with a molecular weight of 1183.34 2
- It has enhanced antidiuretic potency but markedly diminished pressor activity compared to natural vasopressin 3
- The biphasic half-lives for intranasal desmopressin are 7.8 and 75.5 minutes for fast and slow phases, providing prompt onset with long duration of action 2
- DDAVP acts by increasing the concentration of von Willebrand factor and factor VIII in the bloodstream 1
- It may have direct effects on platelets that are not fully characterized 1
- Terminal half-life significantly increases from 3 hours in healthy patients to 9 hours in patients with severe renal impairment 2
Clinical Applications
Hematological Uses
- DDAVP is indicated for treatment of mild type I von Willebrand disease and mild hemophilia A with FVIII levels at least 5% of normal 1, 3
- Standard dosing for hemostatic purposes is 0.3 μg/kg diluted in 50 ml saline and infused over 30 minutes 1
- It can be used as a nontransfusional hemostatic agent in many bleeding disorders 4
- For patients with type 2B von Willebrand disease, human-derived FVIII concentrates complexed to Willebrand factor are preferred over DDAVP due to safety concerns 5
Antiplatelet Therapy Considerations
- DDAVP has been used to manage bleeding in patients on antiplatelet therapy, though evidence for efficacy is uncertain 1
- It has limited efficacy with newer antiplatelet agents like ticagrelor and prasugrel 1
- Studies show it did not reduce bleeding in rabbits treated with prasugrel and did not correct platelet function in healthy volunteers treated with ticagrelor 6
Other Uses
- DDAVP is the treatment of choice for central diabetes insipidus and can be administered either intranasally or parenterally 3, 7
- It can shorten the prolonged bleeding time in patients with uremia, liver cirrhosis, and platelet dysfunctions 4, 8
Administration Routes
- Available as intranasal spray solution (0.01%) delivering 10 mcg per spray 2
- Can be administered intravenously at 0.3-0.4 mcg/kg 9
- Intranasal administration has about one-tenth the antidiuretic effect of an equivalent injected dose 2
Safety Considerations and Adverse Effects
- DDAVP can cause systemic vasodilator effects leading to arterial hypotension, reactive tachycardia, and facial flushing 6
- It may cause oliguria, hypervolemia, and hyponatremia 6
- Water intoxication and hyponatremia are major complications of DDAVP therapy 7
- Rare cases of thromboembolic events have been reported, requiring caution in at-risk patients 6
- DDAVP is mainly excreted in the urine, with significantly longer half-life in patients with renal impairment 2
Clinical Efficacy in Different Settings
- Meta-analyses suggest DDAVP can reduce RBC transfusion, blood loss, and reoperations due to bleeding in certain surgical settings 1
- However, prophylactic use in cardiac surgery has shown inconsistent benefits 1
- A randomized trial including patients on dual antiplatelet therapy undergoing coronary artery bypass surgery found desmopressin was not associated with a reduction in blood loss 6
- For patients with von Willebrand's disease, equivalent shortening of bleeding time was observed with both intravenous and intranasal administration 9