The Effect of DDAVP Infusion on Thrombin Generation in Platelet-rich Plasma of von Willebrand Type 1 and in Mild Haemophilia A Patients

Irene M. L. W. Keularts; K. Hamulyak; H.C. Hemker; Suzette Béguin

doi:10.1055/s-0037-1614080

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2000; 84(04): 638-642
DOI: 10.1055/s-0037-1614080

Review Article

Schattauer GmbH

The Effect of DDAVP Infusion on Thrombin Generation in Platelet-rich Plasma of von Willebrand Type 1 and in Mild Haemophilia A Patients

Irene M. L. W. Keularts

¹From the Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM) and Medical Faculty University of Maastricht, The Netherlands, Academic Hospital Maastricht, The Netherlands

,

K. Hamulyak

¹From the Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM) and Medical Faculty University of Maastricht, The Netherlands, Academic Hospital Maastricht, The Netherlands

,

H.C. Hemker

¹From the Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM) and Medical Faculty University of Maastricht, The Netherlands, Academic Hospital Maastricht, The Netherlands

,

Suzette Béguin

¹From the Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM) and Medical Faculty University of Maastricht, The Netherlands, Academic Hospital Maastricht, The Netherlands

› Institutsangaben

Abstract

Summary

In von Willebrand disease (vWD) type 1 and mild haemophilia A patients we studied the effect of an infusion of DDAVP (0.3 µg/kg body weight) on thrombin generation in platelet-rich plasma (PRP) and platelet-poor plasma (PPP). Baseline thrombin generation in PRP was diminished both in the haemophilia A and vWD patients. It was normal in vWD plasma when sufficient procoagulant phospholipids were present, either via adding phospholipid vesicles to PPP or via scrambling of the platelet membrane with ionomycin in PRP. In haemophilia A plasma, thrombin generation did not normalize by providing procoagulant phospholipids. Treatment with DDAVP temporarily restored thrombin generation in PRP to normal in both diseases.

To investigate the individual roles of von Willebrand factor (vWF) and factor VIII, we also studied the effect of factor VIII infusion on thrombin generation in a severe haemophilia patient. It appears that at a fixed normal vWF concentration, <25% factor VIII is sufficient for normal thrombin generation in PRP. At a sufficient factor VIII concentration, however, thrombin generation is still lower than normal in vWD patients; ∼40% of vWF is required for half-normal thrombin generation in PRP.

It thus appears that vWF is also a clotting factor, in the sense that it is required for normal thrombin generation. This underlines the importance of the interaction between coagulation and the platelets in normal haemostasis. Thrombin generation in PRP appears to be a suitable test to reflect the combined function.

Key words

Thrombin generation - von Willebrand factor - factor VIII - DDAVP

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Referenzen

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