title: Infusion of DDAVP does not improve primary hemostasis in patients with cirrhosis.
abstract: OBJECTIVE
  Cirrhosis frequently affects multiple components of hemostasis. Reversal of the coagulopathy of these patients is frequently required in case of bleeding episodes, or as prophylaxis before invasive procedures. Although 1-deamino-8-D-arginine vasopressin (DDAVP) is widely used as a pro-hemostatic agent in patients with cirrhosis, it is unclear whether DDAVP truly enhances hemostasis in these patients. Here we investigated the hemostatic effects of a single bolus of DDAVP in patients with cirrhosis.
  
  
  METHODS
  Ten patients with cirrhosis (child B or C) and ten patients with mild haemophilia A received an intravenous single bolus of 0.3 microgram/kg DDAVP. Plasma was collected prior to and at 1, 3, 6, and 24 h after DDAVP administration. Levels of Von Willebrand factor (VWF), VWF propeptide, factor VIII (FVIII), and ADAMTS13 were measured in all plasma samples, whereas VWF multimers and functional VWF-dependent platelet adhesion were determined in the samples pre- and 1 h after DDAVP administration.
  
  
  RESULTS
  Following DDAVP administration, VWF, FVIII, and VWF propeptide levels increased in patients with haemophilia, while patients with cirrhosis only showed an increase in VWF propeptide and FVIII levels. High molecular weight VWF multimers and VWF-dependent platelet adhesion increased in patients with haemophilia one hour after DDAVP administration, but did not change in the patients with cirrhosis. Levels of ADAMTS13 were unaffected in both patient groups after DDAVP.
  
  
  CONCLUSIONS
  The lack of relevant effects of DDAVP on laboratory indices of primary hemostasis in patients with cirrhosis is in line with previous clinical study results in these patients.
authors.affiliation: Surgical Research Laboratory, University Medical Center Groningen, Groningen, The Netherlands.|Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Freeha
authors.initials: F
authors.lastname: Arshad
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Sara C M
authors.initials: SC
authors.lastname: Stoof
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Frank W G
authors.initials: FW
authors.lastname: Leebeek
authors.affiliation: Surgical Research Laboratory, University Medical Center Groningen, Groningen, The Netherlands.|Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: Ruitenbeek
authors.affiliation: Surgical Research Laboratory, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: Adelmeijer
authors.affiliation: Department of Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Blokzijl
authors.affiliation: Department of Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Arie P
authors.initials: AP
authors.lastname: van den Berg
authors.affiliation: Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Marieke J H A
authors.initials: MJ
authors.lastname: Kruip
authors.affiliation: Surgical Research Laboratory, University Medical Center Groningen, Groningen, The Netherlands.|Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Ton
authors.initials: T
authors.lastname: Lisman
mesh_terms: D051722:ADAM Proteins / Q000097:blood; D000071120:ADAMTS13 Protein; D000328:Adult; D015415:Biomarkers / Q000097:blood; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D006467:Hemophilia A / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006487:Hemostasis / Q000187:drug effects*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D013997:Time Factors; D016896:Treatment Outcome; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D015415:Biomarkers; D006490:Hemostatics; D014841:von Willebrand Factor; C078147:F8 protein, human; D005169:Factor VIII; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human; D003894:Deamino Arginine Vasopressin
keywords: cirrhosis; desmopressin; haemophilia; platelet; von Willebrand factor