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Prepublished online as a Blood First Edition Paper on August 14, 2003; DOI 10.1182/blood-2002-11-3566.
Submitted November 25, 2002
Accepted August 4, 2003
Desmopressin and platelets antagonize the in vitro platelet dysfunction induced by GPIIb/IIIa inhibitors and aspirin
Rosemarie A Reiter, Florian Mayr, Hannes Blazicek, Elisabeth Galehr, Petra Jilma-Stohlawetz, Hans Domanovits, and Bernd Jilma*
Department of Clincal Pharmacology, University of Vienna, Vienna, Austria; Department of Pharmacology, University of Vienna, Vienna, Austria
Department of Blood Group Serology &Transfusion Medicine, University of Vienna, Vienna, Austria
Department of Emergency Medicine, University of Vienna, Vienna, Austria
* Corresponding author; email: bernd.jilma{at}univie.ac.at.
While bleeding is the most frequent adverse event encountered in patients receiving glycoprotein (GP) IIb/IIIa inhibitors, currently no recommendations exist how to treat such patients. The present study tested the hypothesis that infusion of desmopressin (DDAVP) reverses the in vitro platelet dysfunction induced by GPIIb/IIIa inhibitors (+L-aspirin). Study group 1 (ten healthy volunteers) received a DDAVP infusion to establish dose response curves for the in vitro inhibition of platelet function by eptifibatide, abciximab and tirofiban together with L-aspirin before/after DDAVP. Further, in a randomized, double-blind, placebo controlled, cross-over study (group 2) volunteers received L-aspirin and a standard eptifibatide infusion. Thereafter, DDAVP or a physiologic saline infusion were given over 30 min. In group 1 all GPIIb/IIIa inhibitors prolonged collagen/-epinephrine & -adenosine diphosphate closure times (CEPI-CT & CADP-CT), measured with the platelet function analyzer 100 (PFA-100). DDAVP caused a shift in the concentration response curves to the right of all three GPIIb/IIIa inhibitors. In group 2 DDAVP accelerated the normalization of CADP-CT & CEPI-CT after stop of eptifibatide infusion with a maximum effect at 1.5-2h. In contrast, CEPI-CT remained above normal in the placebo group for >4h. In conclusion, DDAVP accelerates normalization of the in vitro platelet dysfunction induced by GPIIb/IIIa inhibitors (+L-aspirin).
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