Desmopressin improves platelet dysfunction measured by in vitro closure time in uremic patients.
OBJECTIVE
Desmopressin decreases bleeding time in uremic patients. Although bleeding time is the most frequently used measure of global platelet function, this test has important disadvantages. In vitro closure time (CT) is a relatively new and efficient test of primary hemostasis. We designed a prospective randomized study to evaluate the effect of desmopressin on platelet function, as measured by in vitro CT, in uremic patients.


METHODS
Forty-eight uremic patients, about to commence hemodialysis and with prolonged CT, were randomized to infusion with desmopressin (n = 24) or saline alone (n = 24). Complete blood count, prothrombin time, activated partial thrombin time, levels of plasma fibrinogen, von Willebrand factor (VWF), factor VIII (FVIII) and CT were measured before and 1 h after desmopressin or saline infusion.


RESULTS
Following desmopressin infusion, collagen/epinephrine and collagen/adenosine diphosphate CT were significantly shortened from 212 +/- 58 to 152 +/- 45 s (p = 0.01) and from 189 +/- 78 to 147 +/- 58 s (p = 0.012), respectively; levels of FVIII and VWF were significantly increased from 188 +/- 66 to 252 +/- 93% (p = 0.017) and from 113 +/- 9 to 121 +/- 9% (p = 0.043), respectively. There were no significant changes in the control group.


CONCLUSIONS
Desmopressin improved platelet dysfunction and increased the plasma concentrations of VWF and FVIII, suggesting that desmopressin may play a role in improving the bleeding tendency in uremic patients.
Lee
Hyun Kee
HK
Department of Internal Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Kim
Yoon Ji
YJ
Jeong
Jin Uk
JU
Park
Jung Sik
JS
Chi
Hyun Sook
HS
Kim
Soon Bae
SB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001791:Blood Platelet Disorders / Q000097:blood* / Q000188:drug therapy*; D001792:Blood Platelets / Q000187:drug effects* / Q000502:physiology; D003894:Deamino Arginine Vasopressin / Q000097:blood / Q000627:therapeutic use*; D005260:Female; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors; D014511:Uremia / Q000097:blood* / Q000188:drug therapy*
D003894:Deamino Arginine Vasopressin