Practical considerations for desmopressin trial/challenge and administration
| Domain . | Description . |
|---|---|
| Route | Desmopressin trials may be performed with either IV or intranasal desmopressin, but intranasal desmopressin trials may not be successful because of issues with administration and/or absorption. Subcutaneous administration has also been used. |
| Dose | IV desmopressin is given as 0.3 μg/kg, with a maximum dose of 20 μg. The desmopressin nasal spray (150 μg per spray) is given as 1 spray for individuals weighing <50 kg and 2 sprays for individuals weighing ≥50 kg. |
| Timing of laboratory testing | VWF antigen, VWF activity, and FVIII activity levels should be determined immediately before administration of desmopressin, ∼30-60 min after administration of desmopressin, and ∼4 h postadministration, because in type 1C VWD, there is a rapid decrease in VWF levels. |
| Responsiveness | There are multiple definitions of desmopressin responsiveness.128-130 The panel considered that an increase of at least 2 times the baseline VWF level and the ability to achieve both VWF and FVIII levels of >0.50 IU/mL were required to consider the patient responsive to desmopressin. Desmopressin responsiveness does not guarantee, however, that the level achieved is adequate to prevent bleeding in all procedures (eg, higher levels may be indicated based on type of procedure). |
| Precautions | Because of the risk of hyponatremia, desmopressin should not be given on >3 concurrent days and is generally not administered to children age <2 y. In addition, tachyphylaxis occurs after repeated infusions. Caution is advised when desmopressin is used in patients with active cardiovascular disease. Additionally, desmopressin trials should be avoided in pregnancy. |
| Domain . | Description . |
|---|---|
| Route | Desmopressin trials may be performed with either IV or intranasal desmopressin, but intranasal desmopressin trials may not be successful because of issues with administration and/or absorption. Subcutaneous administration has also been used. |
| Dose | IV desmopressin is given as 0.3 μg/kg, with a maximum dose of 20 μg. The desmopressin nasal spray (150 μg per spray) is given as 1 spray for individuals weighing <50 kg and 2 sprays for individuals weighing ≥50 kg. |
| Timing of laboratory testing | VWF antigen, VWF activity, and FVIII activity levels should be determined immediately before administration of desmopressin, ∼30-60 min after administration of desmopressin, and ∼4 h postadministration, because in type 1C VWD, there is a rapid decrease in VWF levels. |
| Responsiveness | There are multiple definitions of desmopressin responsiveness.128-130 The panel considered that an increase of at least 2 times the baseline VWF level and the ability to achieve both VWF and FVIII levels of >0.50 IU/mL were required to consider the patient responsive to desmopressin. Desmopressin responsiveness does not guarantee, however, that the level achieved is adequate to prevent bleeding in all procedures (eg, higher levels may be indicated based on type of procedure). |
| Precautions | Because of the risk of hyponatremia, desmopressin should not be given on >3 concurrent days and is generally not administered to children age <2 y. In addition, tachyphylaxis occurs after repeated infusions. Caution is advised when desmopressin is used in patients with active cardiovascular disease. Additionally, desmopressin trials should be avoided in pregnancy. |