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DDAVP shortens the prolonged bleeding times of patients with severe von
Willebrand disease treated with cryoprecipitate. Evidence for a mechanism
of action independent of released von Willebrand factor
M Cattaneo, M Moia, P Delle Valle, P Castellana and PM Mannucci
A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
After infusion of cryoprecipitate, the very prolonged bleeding time of
patients with severe von Willebrand disease (vWD) is shortened but not
always normalized in spite of normalization of plasma von Willebrand factor
(vWF) levels. Therefore treatments that further improve primary hemostasis
in severe vWD patients are needed. Since DDAVP shortens the bleeding time
in a variety of bleeding disorders, we investigated in a double-blind,
placebo-controlled crossover study the effects of the intravenous (IV)
infusion of DDAVP (0.3 microgram/kg) on the bleeding times of 10 patients
with severe vWD treated with cryoprecipitate. Their very prolonged bleeding
times (greater than 30 minutes), partially corrected by the infusion of
cryoprecipitate (14 +/- 2 minutes, mean +/- SEM), were further shortened by
the administration of DDAVP (9 +/- 2 minutes, P less than .01) but not of
saline (15 +/- 3 minutes, ns). Plasma vWF levels, raised from unmeasurable
to normal values by cryoprecipitate, were not changed after DDAVP or
saline. The defective deposition of platelets from eight patients onto
human umbilical artery subendothelium was increased but not normalized by
cryoprecipitate and was not significantly affected by DDAVP or saline.
Therefore the infusion of DDAVP after cryoprecipitate may be of clinical
benefit for management of bleeding episodes in severe vWD patients. Since
severe vWD patients do not have releasable tissue stores of vWF, DDAVP must
shorten their prolonged bleeding times independently of released vWF.
Volume 74,
Issue 6,
pp. 1972-1975,
11/01/1989
Copyright © 1989 by The American Society of Hematology
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