Desmopressin (Surgical — Haemostasis/Platelet Dysfunction)

How it works

It releases stored von Willebrand factor and factor VIII from endothelium and enhances platelet adhesion, transiently improving primary haemostasis.

Prescribing in practice

• It has an antidiuretic effect and can cause dilutional hyponatraemia and seizures, so restrict fluid intake and monitor sodium, with particular caution in young children and the elderly.
• Tachyphylaxis occurs with repeated dosing as factor stores deplete, limiting its usefulness for prolonged bleeding.
• Use cautiously in cardiovascular disease because of fluid retention and rare thrombotic events, and avoid in type 2B von Willebrand disease.

Monitoring

Monitor serum sodium, fluid balance, blood pressure and the haemostatic response when used to cover surgery or bleeding.

Counselling the patient

• Limit how much you drink for the period advised after the dose to protect your salt levels.
• Report headache, nausea, confusion or drowsiness promptly.

Evidence & guidelines

Its haemostatic use is established in haemophilia and von Willebrand disease management guidelines and supported by long-standing clinical use.