title: Desmopressin-related myocardial infarction in a patient with Wegener's granulomatosis: a case report and review of the literature.
abstract: Desmopressin is a synthetic vasopressin analog that increases the plasma levels of coagulation factor VIII, von Willebrand factor, and tissue plasminogen activator. This hemostatic agent, which can be administered either parenterally or intranasally, has been approved for use in the prevention and treatment of hemorrhagic events during surgery in patients with hemophilia A, in cases of prolonged idiopathic bleeding, and for complications associated with platelet antiaggregant therapy. This case report describes cardiac toxicity associated with desmopressin administered according to the recommended indications: a 55-year-old woman diagnosed with Wegener's granulomatosis (WG) was treated with desmopressin to improve hemostasis and shorten bleeding time before a planned renal biopsy. She developed cardiac arrest within 60 minutes of the desmopressin injection. Cardiopulmonary resuscitation began immediately and was successful, although the patient subsequently died of WG-associated complications. Desmopressin administration thus appears, in some cases, to be associated with a high risk of thrombotic events, possibly by stimulating the rapid release of endothelial factors such as an abnormal multimeric form of von Willebrand factor, which might cause platelet aggregation. Clinicians should be aware of the possible occurrence of this little-known but potentially serious cardiac event associated with desmopressin administration and be prepared to initiate cardiopulmonary resuscitation immediately if needed.
authors.affiliation: Dermatology department, hôpital Huriez, university hospital, 59037 Lille, France. emeline.pape@chru-lille.fr
authors.forename: E
authors.initials: E
authors.lastname: Pape
authors.forename: J
authors.initials: J
authors.lastname: Béné
authors.forename: A-L
authors.initials: AL
authors.lastname: Buchdahl
authors.forename: S
authors.initials: S
authors.lastname: Gautier
authors.forename: P-Y
authors.initials: PY
authors.lastname: Hatron
authors.forename: M
authors.initials: M
authors.lastname: Lambert
mesh_terms: D001704:Biopolymers; D001706:Biopsy; D001760:Bleeding Time; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects* / Q000627:therapeutic use; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000187:drug effects / Q000378:metabolism; D017809:Fatal Outcome; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006323:Heart Arrest / Q000139:chemically induced*; D006470:Hemorrhage / Q000517:prevention & control; D006490:Hemostatics / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology*; D013923:Thromboembolism / Q000209:etiology; D015912:Thrombolytic Therapy; D014841:von Willebrand Factor / Q000737:chemistry / Q000378:metabolism
chemical_list: D001704:Biopolymers; D006490:Hemostatics; D007166:Immunosuppressive Agents; D014841:von Willebrand Factor; D003894:Deamino Arginine Vasopressin