RSS-Feed abonnieren
DOI: 10.1055/s-0038-1647492
Heparin, DDAVP and the Bleeding Time
Publikationsverlauf
Received: 17. August 1990
Accepted after revision 30. Oktober 1990
Publikationsdatum:
02. Juli 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199103/lookinside/thumbnails/10-1055-s-0038-1647492-1.jpg)
Summary
The effect on the bleeding time of heparin, followed by an infusion with desmopressin (DDAVP) 0.3 Μg/kg or placebo in a randomized, double-blind set-up, was investigated in 20 patients treated for acute venous thromboembolism. The bleeding time was on the average prolonged by 90% (95% confidence interval 46% -134%) after at least 1 day of treatment with heparin. At that point DDAVP shortened the bleeding time by 23% with a confidence interval of −35% to −11% whereas the effect of placebo was −2% with a confidence interval of −23% to +20%. There was also a shortening of the APTT after DDAVP but not after placebo. It is concluded that DDAVP induces a partial reversal of the effect of heparin on the bleeding time, and that DDAVP should be tried in case of hemorrhagic problems.
-
REFERENCES
- 1 Levine MN, Hirsh J. Hemorrhagic complications of anticoagulant therapy. Semin Thromb 1986; 12: 39-47
- 2 Salzman EW, Deykin D, Shapiro RM, Rosenberg R. Management of heparin therapy. Controlled prospective trial. N Engl J Med 1975; 292: 1046-1050
- 3 Glazier RL, Crowell EB. Randomized prospective trial of continuous vs intermittent heparin therapy. JAMA 1976; 236: 1365-1367
- 4 Mant MJ, Thong KL, Birtwhistle RV, O’Brien BD, Hammond GD, Grace MG. Hemorrhagic complications of heparin therapy. Lancet 1977; 1: 1135-1150
- 5 Wilson JR, Lampman J. Heparin therapy: A randomized prospective study. Am Heart J 1979; 97: 155-158
- 6 Bentley PG, Kakkar W, Scully MF, MacGregor IR, Webb P, Chan P, Jones N. An objective study of alternative methods of heparin administration. Thromb Res 1980; 18: 177-187
- 7 Andersson G, Fagrell B, Holmgren K, Johnsson H, Ljungberg B, Nilsson E, Wilhelmsson S, Zetterquist S. Subcutaneous administration of heparin, a randomized comparison with intravenous administration of heparin to patients with deep-vein thrombosis. Thromb Res 1982; 27: 631-639
- 8 Schulman S. Studies on the medical treatment of deep vein thrombosis. Acta Med Scand 1985; (Suppl. 704) 1-68
- 9 Mannucci PM. Desmopressin: a nontransfusional form of treatment for congenital and acquired bleeding disorders. Blood 1988; 72: 1449-1455
- 10 Kobrinsky NL, Israel ED, Gerrard JM, Cheang MS, Watson CM, Bishop AJ, Schroeder ML. Shortening of bleeding time by 1-deamino-8-D-arginine vasopressin in various bleeding disorders. Lancet 1984; 1: 1145-1148
- 11 Drouet L, Scrobohaci ML, Boudaoud S, Vilain G. Desmopressin (dDAVP): a powerful hemostation agent. Nouv Rev Fr Hematol 1989; 31: 163-165
- 12 Lethagen S, Åberg M, Rugarn P, Nilsson IM. Effects of desmopressin acetate (DDAVP) and dextran on hemostasis and blood viscosity. Thromb Haemostas 1989; 62: 159
- 13 Heiden D, Mielke Jr CH, Rodvien R. Impairment by heparin of primary haemostasis and platelet [14C]5-hydroxytryptamine release. Br J Haematol 1977; 36: 427-435
- 14 Van Ryn-McKenna J, N’guyen P, Ofosu FA, Hirsh J, Buchanan MR. The effetcs of DDAVP on heparin-induced bleeding. Thromb Haemorrh Disorders 1990; 1: 23-27
- 15 Barrowcliffe TW, Merton RE, Gray E, Thomas DP. Heparin and bleeding: an association with lipase release. Thromb Haemostas 1988; 60: 434-436
- 16 Köhler M, Hellstern P, Reiter B, von Blohn G, Wenzel E. The subcutaneous administration of the vasopressin analogue 1-desamino-8-D-arginine vasopressin in patients with von Willebrand’s disease and hemophilia. Klin Wochenschr 1984; 62: 543-548
- 17 Bichet DG, Razi M, Lonergan M, Arthus M-F. 1-desamino [8-D-arginine]vasopressin (dDAVP) decreases blood pressure and increases pulse rate in normal individuals. Thromb Haemostas 1988; 60: 348-649
- 18 MacGregor IR, Prowse CV. 1-desamino (8-D-arginine) vasopressin (dDAVP) decreases blood pressure and increases pulse rate in normal individuals - reply. Thromb Haemostas 1989; 61: 327