J Windyga1, G Dolan2, C Altisent3, O Katsarou4, M-F López Fernández5, B Zülfikar6. 1. Department of Disorders of Hemostasis and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland. 2. Queen's Medical Centre, University Hospital, Nottingham, UK. 3. Servicio de Hematologia - Unidad de Hemofilia, Hospital Vall D'Hebron, Barcelona, Spain. 4. Thrombosis and Haemostasis Unit, Laikon General Hospital, Athens, Greece. 5. Servicio Hematologia, Complexo Hospitalario A Coruña, INIBIC. Avenida del Pasaje., La Coruña, Spain. 6. Department of Pediatric Hematology, Istanbul University Cerrahpasa Faculty of Medicine, Cerrahpasa, Istanbul, Turkey.
Abstract
INTRODUCTION: Desamino D-arginine vasopressin (DDAVP or desmopressin) is a useful and effective haemostatic treatment for patients with von Willebrand Disease (VWD). However, there are still issues regarding in which subtypes of VWD DDAVP is appropriate and little consensus on its use in different surgical settings. We also lack information concerning the appropriate laboratory parameters that should be monitored. AIM: The European Haemophilia Therapy Strategy Board (EHTSB) wished to investigate published information and clinical use of DDAVP in VWD patients. METHODS: We conducted a literature survey on management of VWD during surgical interventions and undertook a survey of specialist haematologist centres across Europe to assess current management of VWD patients. RESULTS: DDAVP is ineffective in type 3 VWD and its use in type 2B remains controversial due to the possibility of thrombocytopenia. It can, however, be used effectively to cover minor surgery and dental procedures in most other VWD patients. For major surgery there is wider use of factor concentrate in preference to DDAVP depending on the subtype of VWD. We give consensus recommendations on the use of DDAVP for surgical interventions in VWD including laboratory parameters that denote an adequate response and contraindications to its use. CONCLUSIONS: DDAVP can be recommended to cover invasive procedure in selected patients with VWD, however, we need more information and systematic recording of adverse events associated with DDAVP use in VWD. A companion paper will be published covering the use of factor concentrates in VWD patients.
INTRODUCTION: Desamino D-arginine vasopressin (DDAVP or desmopressin) is a useful and effective haemostatic treatment for patients with von Willebrand Disease (VWD). However, there are still issues regarding in which subtypes of VWD DDAVP is appropriate and little consensus on its use in different surgical settings. We also lack information concerning the appropriate laboratory parameters that should be monitored. AIM: The European Haemophilia Therapy Strategy Board (EHTSB) wished to investigate published information and clinical use of DDAVP in VWDpatients. METHODS: We conducted a literature survey on management of VWD during surgical interventions and undertook a survey of specialist haematologist centres across Europe to assess current management of VWDpatients. RESULTS: DDAVP is ineffective in type 3 VWD and its use in type 2B remains controversial due to the possibility of thrombocytopenia. It can, however, be used effectively to cover minor surgery and dental procedures in most other VWDpatients. For major surgery there is wider use of factor concentrate in preference to DDAVP depending on the subtype of VWD. We give consensus recommendations on the use of DDAVP for surgical interventions in VWD including laboratory parameters that denote an adequate response and contraindications to its use. CONCLUSIONS: DDAVP can be recommended to cover invasive procedure in selected patients with VWD, however, we need more information and systematic recording of adverse events associated with DDAVP use in VWD. A companion paper will be published covering the use of factor concentrates in VWDpatients.
Authors: Nathan T Connell; Paula D James; Romina Brignardello-Petersen; Rezan Abdul-Kadir; Barbara Ameer; Alice Arapshian; Susie Couper; Jorge Di Paola; Jeroen Eikenboom; Nicolas Giraud; Jean M Grow; Sandra Haberichter; Vicki Jacobs-Pratt; Barbara A Konkle; Peter Kouides; Michael Laffan; Michelle Lavin; Frank W G Leebeek; Claire McLintock; Simon McRae; Robert Montgomery; Sarah H O'Brien; James S O'Donnell; Margareth C Ozelo; Nikole Scappe; Robert Sidonio; Alberto Tosetto; Angela C Weyand; Mohamad A Kalot; Nedaa Husainat; Reem A Mustafa; Veronica H Flood Journal: Blood Adv Date: 2021-01-26