Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years.

I the enhancement of blood clotting associated with stress was caused by the liberation of adrenaline in plasma. In 1957, N 1977 DESMOPRESSIN (1-deamino-8-D-arginine vasopressin, abbreviated DDAVP), a derivative of the antidiuretic hormone, was used for the first time to treat patients a possible mechanism for faster clotting after adrenaline was provided by Marciniak, who found a transient increase in with hemophilia A and von Willebrand disease (vWD), the most frequent congenital bleeding disorders. After the origicoagulation factor VIII after injection in rabbits. Reports of raised factor VIII after adrenaline infusion in humans soon nal clinical study performed in Italy, desmopressin was used in many other countries and the World Health Organization followed: the average increase was to about twice the starting level, with no measurable change in other clotting factors. included it in the list of essential drugs. A drug that could raise the plasma levels of factor VIII and von Willebrand In patients with mild hemophilia the magnitude of the factor VIII increase induced by adrenaline was similar to that elicfactor (vWF) without the need of blood products was especially attractive in the late 1970s and early 1980s, a time ited in healthy individuals. These findings stimulated further research, with the goal when the human immunodeficiency virus began to be transmitted by infected coagulation factor concentrates to patients to identify a factor VIII–increasing agent that would be free of the side effects of adrenaline and could be administered with congenital coagulation disorders. The clinical indications for desmopressin quickly exto hemophilic patients as autologous replacement therapy. Vasopressin and insulin also induced an increase of factor panded beyond hemophilia and vWD. The compound was shown to be efficacious even in bleeding disorders not inVIII, but their side effects were not milder than those of adrenaline, making clinical use unrealistic. An important step volving a deficiency or dysfunction of factor VIII or vWF, including congenital and acquired defects of platelet function forward was made with the observation that desmopressin, a synthetic analogue of vasopressin, increased factor VIII and such frequent abnormalities of hemostasis as those associated with chronic kidney and liver diseases. Desmopressin and vWF in healthy individuals. Unlike the natural antidiuretic hormone, desmopressin produced little or no vasoconhas also been used prophylactically in patients undergoing surgical operations characterized by large blood loss and striction, no increase in blood pressure, and no contraction of the uterus or gastrointestinal tract, so that it was well transfusion requirements. Twenty years of clinical experience have now established tolerated when administered to humans. A big step forward was taken when desmopressin was more firmly the clinical indications of desmopressin. Some of these indications have been strengthened by the experiused in patients for the prevention and treatment of bleeding, first during dental extractions and then during major surgical ence accumulated, others have not been supported by rigorous clinical trials or have been overcome by the advent of procedures with mild hemophilia A or vWD. Surgery was performed without blood products, demonstrating that autolmore efficacious treatments. This report reviews the spectrum of indications in bleeding disorders, in the attempt to ogous factor VIII and vWF increased in patient plasma by desmopressin could effectively replace homologous factors establish which indications remain valid and which do not. Topics such as pharmacokinetics, pharmacodynamics, and contained in blood products. These clinical results were soon confirmed. side effects of desmopressin will not be dealt with because they are covered in previous reviews.