From the Guidelines
DDAVP does not have a established efficacy in improving APTT in patients on antiplatelet therapy, and its use is not recommended due to potential safety concerns. The study by the French working group on perioperative haemostasis (GIHP) in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR) published in 2019 in the journal Anaesthesia 1 suggests that desmopressin's efficacy in neutralizing the effect of antiplatelet agents (APAs) is very uncertain. Although desmopressin may have some effects on platelet function, its clinical demonstration of efficacy has been inadequate.
Some key points to consider when evaluating the use of DDAVP in this context include:
- The lack of clinical trials demonstrating its efficacy in reducing bleeding in patients on modern antiplatelet therapy, such as prasugrel or ticagrelor 1
- The potential safety concerns associated with its use, including systemic vasodilator effects, arterial hypotension, reactive tachycardia, facial flush, oliguria, hypervolemia, and hyponatremia 1
- The risk of thromboembolic events, particularly in patients at risk 1
- The limited evidence supporting its use in cardiac surgery, with most trials being outdated and having significant heterogeneity in patient populations and outcomes 1
In clinical practice, the use of DDAVP to improve APTT in patients on antiplatelet therapy is not supported by strong evidence, and its potential risks and limitations should be carefully considered. Alternative strategies to manage bleeding risk in these patients should be explored, taking into account the individual patient's clinical context and the latest available evidence.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
DDAVP and APTT
- The provided studies do not directly address the effect of DDAVP on activated partial thromboplastin time (APTT) [ 2, 3, 4, 5, 6 ].
- However, it is known that DDAVP increases plasma concentrations of coagulation factor VIII and von Willebrand factor, which can affect APTT [ 2 ].
- The studies focus on the use of DDAVP in patients with mild hemophilia A or von Willebrand disease, and its effectiveness in increasing factor VIII and von Willebrand factor levels [ 3, 4, 5 ].
- One study suggests that DDAVP response is influenced by various factors, including baseline factor VIII activity and von Willebrand factor antigen levels [ 5 ].
- A systematic review and meta-analysis found that response to DDAVP varies between disease subtypes and is largely determined by baseline levels of factor VIII and von Willebrand factor [ 6 ].
Factors Influencing DDAVP Response
- Baseline factor VIII activity is a significant determinant of response to DDAVP in hemophilia A patients [ 5, 6 ].
- Von Willebrand factor antigen levels are a significant determinant of response to DDAVP in von Willebrand disease type 1 patients [ 6 ].
- Age, sex, and specific mutations in the VWF and F8 genes may also influence response to DDAVP [ 6 ].