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Infusion of DDAVP does not improve primary hemostasis in patients with cirrhosis
Author(s) -
Arshad Freeha,
Stoof Sara C.M.,
Leebeek Frank W.G.,
Ruitenbeek Karin,
Adelmeijer Jelle,
Blokzijl Hans,
Berg Arie P.,
Porte Robert J.,
Kruip Marieke J.H.A.,
Lisman Ton
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12765
Subject(s) - hemostasis , medicine , von willebrand factor , cirrhosis , desmopressin , vasopressin , coagulopathy , haemophilia , platelet , gastroenterology , bolus (digestion) , haemophilia a , endocrinology , surgery
Background & Aims Cirrhosis frequently affects multiple components of hemostasis. Reversal of the coagulopathy of these patients is frequently required in case of bleeding episodes, or as prophylaxis before invasive procedures. Although 1‐deamino‐8‐D‐arginine vasopressin ( DDAVP ) is widely used as a pro‐hemostatic agent in patients with cirrhosis, it is unclear whether DDAVP truly enhances hemostasis in these patients. Here we investigated the hemostatic effects of a single bolus of DDAVP in patients with cirrhosis. Methods Ten patients with cirrhosis (child B or C) and ten patients with mild haemophilia A received an intravenous single bolus of 0.3 microgram/kg DDAVP . Plasma was collected prior to and at 1, 3, 6, and 24 h after DDAVP administration. Levels of Von Willebrand factor ( VWF ), VWF propeptide, factor VIII ( FVIII ), and ADAMTS 13 were measured in all plasma samples, whereas VWF multimers and functional VWF ‐dependent platelet adhesion were determined in the samples pre‐ and 1 h after DDAVP administration. Results Following DDAVP administration, VWF , FVIII , and VWF propeptide levels increased in patients with haemophilia, while patients with cirrhosis only showed an increase in VWF propeptide and FVIII levels. High molecular weight VWF multimers and VWF ‐dependent platelet adhesion increased in patients with haemophilia one hour after DDAVP administration, but did not change in the patients with cirrhosis. Levels of ADAMTS 13 were unaffected in both patient groups after DDAVP . Conclusion The lack of relevant effects of DDAVP on laboratory indices of primary hemostasis in patients with cirrhosis is in line with previous clinical study results in these patients.