From the Guidelines
Desmopressin is a valuable treatment option for patients with uremic coagulopathy, as it enhances platelet function and can be administered via IV, subcutaneously, or intranasally at a dose of 0.3 mg/kg, with effects lasting 6-8 hours. According to the study published in Gastroenterology in 2019 1, desmopressin may be given IV or subcutaneously at a dose of 0.3 mg/kg, or 3 mg/kg can be given intranasally, with the hemostatic effect typically detected within 1 hour. The medication is particularly useful for patients with end-stage renal disease and uremic platelet dysfunction.
The key benefits of desmopressin in uremic coagulopathy include:
- Enhancing platelet function, which reduces the risk of bleeding
- Increasing von Willebrand factor levels, which improves platelet adhesion and aggregation
- Providing a rapid onset of action, with effects detectable within 1 hour
- Offering a relatively long duration of action, lasting 6-8 hours
It is essential to note that desmopressin may not be suitable for all patients, and its use should be carefully considered in the context of each individual case. However, for patients with uremic coagulopathy, desmopressin can be a valuable treatment option to reduce the risk of bleeding and improve outcomes. As stated in the study 1, desmopressin may be appropriate for administration to patients with end-stage renal disease and uremic platelet dysfunction.
In terms of administration, desmopressin can be given via IV, subcutaneously, or intranasally, offering flexibility in terms of dosing and administration. The typical dose is 0.3 mg/kg, and the medication can be administered in a variety of settings, including before invasive procedures or to manage acute bleeding episodes. Overall, desmopressin is a useful treatment option for patients with uremic coagulopathy, and its use should be considered in the context of each individual case.
From the FDA Drug Label
Desmopressin acetate has been shown to be more potent than arginine vasopressin in increasing plasma levels of factor VIII activity in patients with hemophilia and von Willebrand’s disease Type I. The FDA drug label does not answer the question.
From the Research
Mechanism of Desmopressin in Uremic Coagulopathy
- Desmopressin improves platelet function in uremic patients by increasing the release of von Willebrand factor (VWF) and factor VIII from endothelial cells 2, 3, 4.
- It shortens the collagen/epinephrine-closure time, a measure of platelet function, indicating improved platelet aggregation and adhesion 2, 3.
- Desmopressin also increases the plasma concentrations of VWF and factor VIII, which are essential for platelet adhesion and aggregation 3, 4.
Clinical Benefits of Desmopressin
- Desmopressin reduces the risk of bleeding in uremic patients undergoing invasive procedures, such as central catheter insertion, percutaneous nephrostomy, and angiography 2.
- It decreases the need for red blood cell transfusions and reduces blood loss in patients with platelet dysfunction undergoing surgery 5.
- Desmopressin may be a useful agent in reducing bleeding and transfusion requirements for people with platelet dysfunction or with a history of recent antiplatelet drug administration undergoing cardiac surgery 5.
Safety and Efficacy of Desmopressin
- Desmopressin is generally well-tolerated, with few side effects, and can be administered intravenously, subcutaneously, or intranasally 4.
- It has a proven hemostatic efficacy in mild hemophilia A, von Willebrand disease, uremia, liver cirrhosis, and in congenital and acquired platelet dysfunction 4.
- However, observation is advised in small children and elderly patients due to potential side effects 4.