physician University of Pittsburgh Warrendale, Pennsylvania, United States
Background: Desmopressin (DDAVP) is commonly used for the treatment and prevention of bleeding in type 1 von Willebrand disease (VWD). The standard intravenous dose of DDAVP, established more than 40 years ago, is 0.3 mcg/kg of actual body weight (ABW); however, the maximum dose of DDAVP in the United States is often capped at 20 to 30 mcg, reflecting uncertainty whether or not this dose is appropriate in extremes of weight.
Aims: To compare capped and non-capped dosing of DDAVP in patients with type 1 VWD.
Methods: We performed a retrospective chart review of patients with type 1 VWD administered DDAVP intravenously between January 1, 2020, and June 30, 2022, to treat an acute bleed or prevent periprocedural bleeding. The standard DDAVP dose, 0.3 mcg/kg of ABW, was calculated and compared with the administered dose to determine if it was capped. Comparisons were performed between capped and non-capped groups. Outcomes included bleeding treatment efficacy and periprocedural bleeding. Comparisons were performed using Student’s t tests and chi-squared tests.
Results: DDAVP was adminstered for five acute bleeds and 91 invasive procedures. Of these, the DDAVP dose was capped for one bleed and 20 invasive procedures. The most frequently capped doses were 30 and 20 mcg, 33.3 and 28.6%, respectively. The most common invasive procedure was childbirth, 19.8%. Age, sex, and other medical conditions affecting bleeding risk were similar between groups (Table 1). There was no difference in periprocedural bleeding between the capped and non-capped groups, 0.014 vs 0.05%, p=0.33. Acute bleeds were rare (Table 2). One adverse effect, hyponatremia in the non-capped group, was recorded.
Conclusion(s): We found no difference in periprocedural bleeding in patients whose dose of DDAVP was capped at 20 to 30 mcg; thus, providing evidence for the efficacy of adjusted weight-based dosing of DDAVP in obese patients with type 1 VWD.
