From the FDA Drug Label
Post Marketing There have been rare reports of thrombotic events (acute cerebrovascular thrombosis, acute myocardial infarction) following desmopressin acetate injection in patients predisposed to thrombus formation The following adverse reactions have been identified during post-approval use of desmopressin acetate... Cardiovascular: ... thrombotic events
Desmopressin and Cardiovascular Risk
- Desmopressin may increase the risk of thrombotic events, including heart attack and stroke, particularly in patients predisposed to thrombus formation.
- The FDA drug label reports rare cases of acute cerebrovascular thrombosis and acute myocardial infarction following desmopressin acetate injection 1.
- Patients with conditions that increase the risk of fluid or electrolyte imbalance, such as heart failure or uncontrolled hypertension, may be at increased risk of worsening their underlying condition due to fluid retention caused by desmopressin 2 2.
From the Research
Desmopressin may not significantly increase the risk of heart attack or stroke in most patients, but caution is advised in certain individuals, particularly older adults and those with cardiovascular disease, due to its potential to cause hyponatremia and fluid retention. This medication, which is used to treat conditions like diabetes insipidus, nocturnal enuresis, and certain bleeding disorders, works by increasing water reabsorption in the kidneys and promoting blood clotting. According to a recent study 3, the risk factors for developing hyponatremia include extremes of age, existing comorbidity, drug interaction, intranasal formulations, and intercurrent illness. Another study 4 found that desmopressin was associated with a non-significant reduction in hematoma expansion and a similar rate of thrombotic events in patients with antiplatelet-associated intracerebral hemorrhage. However, the available literature does not support the routine use of desmopressin in this setting, and its administration should be judiciously considered on a case-by-case basis. Patients taking desmopressin should monitor for warning signs such as chest pain, shortness of breath, severe headache, confusion, or weakness on one side of the body. To minimize risks, patients should:
- Follow prescribed dosing carefully
- Maintain adequate fluid intake without overhydrating
- Have regular sodium level checks
- Inform their healthcare provider about any cardiovascular symptoms or history of heart disease before starting treatment It is essential to weigh the benefits and risks of desmopressin therapy, considering the individual patient's condition and medical history, as suggested by a study on desmopressin for antiplatelet-associated intracranial hemorrhage 5.