Protocols - Hemorio

DDAVP INDICATIONS
Desmopressin is more effective in patients with VWD type 1. In other subtypes, the response varies. In
subtype 2A there is increase of FVIII, without, however, any change to TS. In subtype 2B and Platelet
Type VWD or pseudo-von Willebrand Disease, Desmopressin is counter-indicated due to risk of transient
plateletopenia occurrence. In subtype 2M, the response pattern is variable and the decision to apply
Desmopressin will depend on the type of response to the test infusion. Desmopressin in subtype 2N
results in high concentrations of FVIII, although it has a short half-life. Type 3 patients, in general, do not
respond to Desmopressin.
It is the chosen treatment for bleedings such as: epistaxis, hematuria, menorrhage, minor traumas and
minor surgeries (dental extraction) in mild hemophilia patients and von Willebrand Disease Type 1 and 2A
carries, the ones responding to DDAVP.
ADMINISTRATION
Desmopressin may be administered through subcutaneous, intravenous or intranasal routes. SUS
(Brazilian Public Health System) makes DDAVP available, in IV presentation. The recommended dose for
intravenous use, in slow infusion of 30 minutes, is 0.3 µg/kg, diluted in 50-100 ml saline solution.
Maximum dose of 20 µg. The concentration peak of FVIII occurs after 30 to 60 minutes of the end of
infusion. It may be repeated in 12 to 24 h. Subsequent doses present less effective responses due to the
tachyphylaxis, because the pre-existing stock would be empty. However, there are studies which show
that the response to the second dose is approximately 30% smaller than the one obtained from the first
dose and in which there are no subsequent reductions in the next doses. The amount of doses applied
should not exceed three.
The recommended dose for subcutaneous use is the same (0.3 µg/kg), however applying to
Desmopressin high concentration presentation (15-20 mcg/ampoule). For intranasal application the
recommended dose is 300µg for adults and 150 µg for children. The use of subcutaneous and intranasal
routes are convenient for the treatment of mild to moderate hemorrhages at home, although they are not
yet made available by the Ministry of Health. After 30 to 60 minutes of Desmopressin administration
intravenous, subcutaneous or intranasal) FVIII and FVW plasma concentrations increased from 3 to 5
times in relation to baseline values. Overall, the response pattern to Desmopressin test is similar in a
family, which can be a guidance to the type of response other family members will present, with no need
to submit them to the therapeutic test.
COLLATERAL EFFECTS
Overall, the collateral effects have little relevance and are related to drugs vasomotor effects such as:
facial redness, mild to moderate headache, hypotension/hypertension and tachycardia. Water retention
and hyponatremia may also arise, due to antidiuretic effects of DDAVP.
NOTES: Special attention must be given to:
1. Elderly patients, due to cases of congestive cardiac failure;
2. Children younger than 3-years-old, especially if receiving endovenous hypotonic solutions, due to the
possibility of developing hyponatremia and convulsions;
3. Patients experiencing unstable angina, due to reports of thromboembolitic phenomena;
4. Carriers of VWD subtype IIB, they may present plateletopenia;
5. Pregnant women, due to possibility of hypervolemia.
COUNTER-INDICATION
1. Patients with previous history of convulsion;
2. Patients with arterial hypertension and cardiopathy;
3. Patients Who developed plateletopenia after “test dose”;
4. Patients with polydypsia.
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