The influence of D.D.A.V.P. on the survival of factor VIII in severe haemophiliacs

McLellan, David; Knight, SC; McLellan, H.G.; Wassef, M.; Aronstam, A

doi:10.1016/0049-3848(85)90355-x

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…Previously, two reports describing the effect of desmopressin-treatment on FVIII survival have been published. First, a study published in 1985 by McLellan and co-workers revealed no effect on FVIII survival upon treatment with desmopressin [28]. It should be noted that this study dates from over 20 years ago.…”

Section: Discussionmentioning

confidence: 84%

Models for Prediction of Factor VIII Half-Life in Severe Haemophiliacs: Distinct Approaches for Blood Group O and Non-O Patients

et al. 2009

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BackgroundVon Willebrand factor (VWF) is critical for the in vivo survival of factor VIII (FVIII). Since FVIII half-life correlates with VWF-antigen pre-infusion levels, we hypothesized that VWF levels are useful to predict FVIII half-life.MethodologyStandardized half-life studies and analysis of pre-infusion VWF and VWF-propeptide levels were performed in a cohort of 38 patients with severe haemophilia A (FVIII <1 IU/ml), aged 15–44 years. Nineteen patients had blood-group O. Using multivariate linear regression-analysis (MVLR-analysis), the association of VWF-antigen, VWF-propeptide, age and body-weight with FVIII half-life was evaluated.Principal FindingsFVIII half-life was shorter in blood-group O-patients compared to non-O-patients (11.5±2.6 h versus 14.3±3.0 h; p = 0.004). VWF-antigen levels correlated with FVIII half-life considerably better in patients with blood-group non-O than O (Pearson-rank = 0.70 and 0.47, respectively). Separate prediction models evolved from MVLR-analysis for blood-group O and non-O patients, based on VWF-antigen and VWF/propeptide ratio. Predicted half-lives deviated less than 3 h of observed half-life in 34/38 patients (89%) or less than 20% in 31/38 patients (82%).ConclusionOur approach may identify patients with shorter FVIII half-lives, and adapt treatment protocols when half-life studies are unavailable. In addition, our data indicate that survival of FVIII is determined by survival of endogenous VWF rather than VWF levels per se.

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Section: Discussionmentioning

confidence: 84%

Models for Prediction of Factor VIII Half-Life in Severe Haemophiliacs: Distinct Approaches for Blood Group O and Non-O Patients

et al. 2009

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“…On average, the levels increase three to four times, with large individual variations (for F VIII from 1·2 to 23·5 times). The half‐life of DDAVP‐induced F VIII is usually shorter (4–5 h with wide interpatient variations) than that of F VIII concentrates ( McLellan et al , 1985 ).…”

Section: Practical Approach To Ddavp Testing and Treatmentmentioning

confidence: 97%

Ddavp Is Not a Panacea for Children With Bleeding Disorders

Sutor

2000

Br J Haematol

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“…The short half-life of DDAVP-derived F VIII is probably not caused by in creased proteolytic action, because DDAVP did not af fect the half-life of F VIII in patients who were infused with both F VIII concentrates and DDAVP. 44 After subcutaneous application, the effect on F VIII and vWF is comparable to that of intravenous adminis tration, except that the peak is reached approximately 1 hour later than it was with the intravenous route. 4,5,37 This mode has been used in children for home treat ment.…”

Section: Erythrocytes (Red Blood Cells [Rbc])mentioning

confidence: 88%

“…34 The rise in the number of right-shifted neutrophils and mono cytes at 3 to 4 hours post infusion suggests that demargination of cells into the peripheral blood occurs that is not mediated via the chemotactic cytokine IL-8. 35 There fore, since WBC can affect hemostasis, alterations of Adapted from Mannici, 4 Lusher, 37 Lethager et al, 38 McLellan et al, 44 Thomas et al 55 WBC could add to the hemostatic effect of DDAVP. In an animal model, it has been shown that DDAVP can di rectly induce P-selectin expression on endothelium in vitro and in vivo and that the latter response is capable of supporting prolonged leukocyte rolling in rat postcapil lary venules.…”

Section: Leukocytes (White Blood Cells [Wbc])mentioning

confidence: 99%

Desmopressin (DDAVP) in Bleeding Disorders of Childhood

Sutor

1998

Semin Thromb Hemost

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As in adults, desmopressin (DDAVP) can be used in children for prophylaxis of bleeding and to stop bleeding in many hereditary and acquired bleeding disorders. DDAVP is the treatment of choice in children with mild hemophilia and type 1 von Willebrand's disease (vWD). It is effective in some variants of vWD and in many patients with platelet function defects. It reduces the bleeding diathesis of children with uremia and drug-induced bleeding complications. In any case, a test dose of DDAVP has to be given to the patient to predict the hemostatic effect before relying on this drug for treatment. The response can be measured by shortening of the bleeding time (BT) and of partial thromboplastin time (PTT), indicating a rise of Factor (F) VIII or von Willebrand factor (vWF). Side effects such as facial flushing, transient headache, increased pulse rate, and drop in systolic blood pressure are mild and transient. They can be minimized when the dose is not exceeding 0.3 microg/kg body weight, and the infusion lasts at least 20 to 30 minutes. The strong antidiuretic action of DDAVP has some potential problems that are negligible in adults and older children when water intake is restricted. In infants and small children under the age of 18 months, however, DDAVP should be used with caution and with close surveillance in order to prevent water intoxication and electrolyte imbalance. The danger is increased when the patients receive parenteral fluid substitution. The advantages of DDAVP include the reduction in the use of plasma factor concentrates, thereby minimizing the danger of immunological or infectious complications, as well as the considerable reduction of costs realized by treatment with this form of medication. Fortunately, it can be applied successfully in the most frequent hereditary bleeding disorder, namely vWD type 1.

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The influence of D.D.A.V.P. on the survival of factor VIII in severe haemophiliacs

Cited by 6 publications

References 7 publications

Models for Prediction of Factor VIII Half-Life in Severe Haemophiliacs: Distinct Approaches for Blood Group O and Non-O Patients

Models for Prediction of Factor VIII Half-Life in Severe Haemophiliacs: Distinct Approaches for Blood Group O and Non-O Patients

Ddavp Is Not a Panacea for Children With Bleeding Disorders

Desmopressin (DDAVP) in Bleeding Disorders of Childhood

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