title: Practical aspects of DDAVP use in patients with von Willebrand Disease undergoing invasive procedures: a European survey.
abstract: BACKGROUND
  Desamino D-arginine vasopressin (DDAVP or desmopressin) is a useful and effective haemostatic treatment for patients with von Willebrand Disease (VWD). However, there are still issues regarding in which subtypes of VWD DDAVP is appropriate and little consensus on its use in different surgical settings. We also lack information concerning the appropriate laboratory parameters that should be monitored.
  
  
  OBJECTIVE
  The European Haemophilia Therapy Strategy Board (EHTSB) wished to investigate published information and clinical use of DDAVP in VWD patients.
  
  
  METHODS
  We conducted a literature survey on management of VWD during surgical interventions and undertook a survey of specialist haematologist centres across Europe to assess current management of VWD patients.
  
  
  RESULTS
  DDAVP is ineffective in type 3 VWD and its use in type 2B remains controversial due to the possibility of thrombocytopenia. It can, however, be used effectively to cover minor surgery and dental procedures in most other VWD patients. For major surgery there is wider use of factor concentrate in preference to DDAVP depending on the subtype of VWD. We give consensus recommendations on the use of DDAVP for surgical interventions in VWD including laboratory parameters that denote an adequate response and contraindications to its use.
  
  
  CONCLUSIONS
  DDAVP can be recommended to cover invasive procedure in selected patients with VWD, however, we need more information and systematic recording of adverse events associated with DDAVP use in VWD. A companion paper will be published covering the use of factor concentrates in VWD patients.
authors.affiliation: Department of Disorders of Hemostasis and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Windyga
authors.affiliation: Queen's Medical Centre, University Hospital, Nottingham, UK.
authors.forename: G
authors.initials: G
authors.lastname: Dolan
authors.affiliation: Servicio de Hematologia - Unidad de Hemofilia, Hospital Vall D'Hebron, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Altisent
authors.affiliation: Thrombosis and Haemostasis Unit, Laikon General Hospital, Athens, Greece.
authors.forename: O
authors.initials: O
authors.lastname: Katsarou
authors.affiliation: Servicio Hematologia, Complexo Hospitalario A Coruña, INIBIC. Avenida del Pasaje., La Coruña, Spain.
authors.forename: M-F
authors.initials: MF
authors.lastname: López Fernández
authors.affiliation: Department of Pediatric Hematology, Istanbul University Cerrahpasa Faculty of Medicine, Cerrahpasa, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Zülfikar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D055815:Young Adult; D014842:von Willebrand Diseases / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D003894:Deamino Arginine Vasopressin
keywords: DDAVP-haemostatic cover; surgical intervention; von Willebrand disease