Desmopressin in the treatment of women’s bleeding disorders

Abstract

Bleeding disorders in women are an underestimated problem that deserves increased attention. About 9%-14% of females have menorrhagia and, amongst them, there is a significant over-representation of von Willebrand disease (VWD), with a prevalence of 13% in this group as compared with about 1% in the general population. The bleeding disorder has not been diagnosed in most of these women and they may therefore be withheld from treatment with desmopressin, which is effective in most cases of VWD and also in platelet dysfunctions and mild factor VIII deficiency. This paper is a review of the haemostatic use of desmopressin with special reference to women's bleeding disorders, the mechanisms of action, modes of administration, clinical indications, dosage recommendations, and hospital or home treatment. Desmopressin stimulates endogenous release of FVIII and von Willebrand factor (VWF), it increases platelet adhesiveness and shortens bleeding time. It can be given as intravenous or subcutaneous injection, but the intranasal spray is probably the most practical mode of administration for females with bleeding disorders as it is simple to administer and suitable for home treatment. The spray has been used successfully in connection with menorrhagia and other bleeding symptoms.

Diagnosis and Management of Mild Bleeding Disorders

“…1,5,[8][9][10]15,[20][21][22]32,37,38 There are trade-offs to consider between benefits and adverse effects of therapy, such as an increased risk of thrombosis (for example, with fibrinolytic inhibitor therapy or from withholding perioperative anticoagulant prophylaxis) and of hyponatremia and seizures with desmopressin. Therapies may, however, offset adverse events, related to hemorrhage, and reduce the need for blood product support (with transfusion reaction/infectious risks).…”

“…1,5,6,8,10,20,22,37,38,39 For many mild bleeding disorders, fibrinolytic inhibitor therapy with Amicar or tranexamic acid is used for dental and oral surgeries and it may reduce bleeding with other operative procedures. 1,5,6,[8][9][10][11]13,20,22,38 Fibrinolytic inhibitor therapy is also helpful for treating some rarer disorders.…”

“…15,20,22,38 Fibrinolytic inhibitors can be helpful for managing excessive menstrual bleeding with unsuccessful cycles in patients attempting to become pregnant. Side effects from DDAVP therapy for menorrhagia (related to fluid retention and hyponatremia with repeated dosing) 37 often restrict use to second-line or adjunctive therapy. Patients may opt for surgical management if future pregnancies are not contemplated and medical therapy is not tolerated.…”

“…Patients may opt for surgical management if future pregnancies are not contemplated and medical therapy is not tolerated. 15,20,22,37,38 Drugs that inhibit platelet function (e.g., aspirin, clopidogrel) and anticoagulants can unmask or induce mild bleeding problems. Desmopressin improves in vitro hemostatic abnormalities induced by anti-platelet therapies 40 but its effectiveness for treating serious bleeding from these drugs is not yet established.…”

“…When the major problem is menorrhagia, the same treatment options used to manage this symptom in individuals with a diagnosed bleeding disorder can be considered. 20,37 However, failure to establish the diagnosis can be problematic for patients that need to undergo surgery or childbirth. Additional testing may uncover abnormalities that were missed (e.g., a platelet secretion defect, mild hemophilia or factor XI deficiency not detected by the PTT, dysfibrinogenemia or partial α2 plasmin inhibitor deficiency).…”