Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders

Karanth, Laxminarayan; Barua, Ankur; Kanagasabai, Sachchithanantham; N, Sreekumaran Nair

doi:10.1002/14651858.cd009824.pub4

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…DDAVP is a synthetic analogue of vasopressin that increases the plasma levels of von Willebrand factor and factor VIII by endothelial release. DDAVP can be used antenatally to raise factor VIII and von Willebrand factor plasma levels two‐ to sixfold during pregnancy in women with haemophilia A and type 1 von Willebrand disease; it has a category B2 safety warning for use in pregnancy in Australia but does not cross the placenta at detectable levels . with peak levels at 30–90 minutes after infusion, although there is considerable inter‐individual variation …”

Section: Management Of Pregnancy and Deliverymentioning

confidence: 99%

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Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy

Dunkley

Curtin

Marren

et al. 2019

Medical Journal of Australia

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IntroductionThere have been significant advances in the understanding of the management of inherited bleeding disorders in pregnancy since the last Australian Haemophilia Centre Directors’ Organisation (AHCDO) consensus statement was published in 2009. This updated consensus statement provides practical information for clinicians managing pregnant women who have, or carry a gene for, inherited bleeding disorders, and their potentially affected infants. It represents the consensus opinion of all AHCDO members; where evidence was lacking, recommendations have been based on clinical experience and consensus opinion.Main recommendationsDuring pregnancy and delivery, women with inherited bleeding disorders may be exposed to haemostatic challenges. Women with inherited bleeding disorders, and their potentially affected infants, need specialised care during pregnancy, delivery, and postpartum, and should be managed by a multidisciplinary team that includes at a minimum an obstetrician, anaesthetist, paediatrician or neonatologist, and haematologist. Recommendations on management of pregnancy, labour, delivery, obstetric anaesthesia and postpartum care, including reducing and treating postpartum haemorrhage, are included. The management of infants known to have or be at risk of an inherited bleeding disorder is also covered.Changes in management as a result of this statementKey changes in this update include the addition of a summary of the expected physiological changes in coagulation factors and phenotypic severity of bleeding disorders in pregnancy; a flow chart for the recommended clinical management during pregnancy and delivery; guidance for the use of regional anaesthetic; and prophylactic treatment recommendations including concomitant tranexamic acid.

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Section: Management Of Pregnancy and Deliverymentioning

confidence: 99%

“…It is important to note that DDAVP can stimulate uterine contraction and cause premature labour, as well as hyponatraemia . It has an antidiuretic effect, and fluids should be restricted to 1 L for 24 hours after use and electrolytes should be monitored…”

Section: Management Of Pregnancy and Deliverymentioning

confidence: 99%

Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy

Dunkley

Curtin

Marren

et al. 2019

Medical Journal of Australia

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“…The use of DDAVP in pregnant women also remains controversial due to the lack of evidence of safety and efficacy in this group. Several cases have been reported, describing complications such as hyponatremia, pre-term delivery, and uterine contractions in this patient group [ 48 ].…”

Section: Current Treatment Optionsmentioning

confidence: 99%

Current and Emerging Options for the Management of Inherited von Willebrand Disease

Heijdra

Cnossen

Leebeek

2017

Drugs

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Von Willebrand disease (VWD) is the most common inherited bleeding disorder with an estimated prevalence of ~1% and clinically relevant bleeding symptoms in approximately 1:10,000 individuals. VWD is caused by a deficiency and/or defect of von Willebrand factor (VWF). The most common symptoms are mucocutaneous bleeding, hematomas, and bleeding after trauma or surgery. For decades, treatment to prevent or treat bleeding has consisted of desmopressin in milder cases and of replacement therapy with plasma-derived concentrates containing VWF and Factor VIII (FVIII) in more severe cases. Both are usually combined with supportive therapy, e.g. antifibrinolytic agents, and maximal hemostatic measures. Several developments such as the first recombinant VWF concentrate, which has been recently licensed for VWD, will make a more “personalized” approach to VWD management possible. As research on new treatment strategies for established therapies, such as population pharmacokinetic-guided dosing of clotting factor concentrates, and novel treatment modalities such as aptamers and gene therapy are ongoing, it is likely that the horizon to tailor therapy to the individual patients’ needs will be extended, thus, further improving the already high standard of care in VWD in most high-resource countries.

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“…However, others have reported a safe outcome even when administered without clamping 25,26 . However, it is to be acknowledged that the use of DDAVP in pregnancy is still controversial and supported by low‐quality evidence derived from observational trials 27 . Moreover, it should be avoided in women with preeclampsia and those with cardiovascular disease 4 .…”

Section: Specific Subpopulations and Proposal Of Therapymentioning

confidence: 99%

Use of the von Willebrand factor concentrate with low factor VIII content to manage patients with inherited von Willebrand disease requiring surgical or secondary long‐term prophylaxis: An expert opinion paper from an Italian panel

Castaman

Borchiellini

Coppola

et al. 2022

European J of Haematology

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Objectives The present review aims to summarize the state‐of‐the‐art von Willebrand disease (VWD) treatment focusing on specific clinical settings (obstetrics, surgery, long‐term prophylaxis and comorbidities) as well as on the use of a Von Willebrand factor (VWF) concentrate with low FVIII content. Methods Literature research and case reports. Results and Conclusions Considering that patients affected by VWD have an intact ability to synthesize FVIII, in order to avoid excessive levels of FVIII, a highly purified plasma VWF concentrate with low FVIII content could be particularly useful in those patients and clinical circumstances at high thrombotic risk as well as for long‐term prophylaxis. When deciding the optimal therapeutic strategy, physicians should take into account both the patient's history and the differences among available concentrates according to the clinical situations requiring treatment.

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Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders

Abstract: Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders (Review)

Cited by 10 publications

References 30 publications

Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy

Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy

Current and Emerging Options for the Management of Inherited von Willebrand Disease

Use of the von Willebrand factor concentrate with low factor VIII content to manage patients with inherited von Willebrand disease requiring surgical or secondary long‐term prophylaxis: An expert opinion paper from an Italian panel

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