Transfusion medicine handbook

8. Clinical Alternatives and Applications

8.5 Desmopressin Acetate Injection (Octostim, Minirin)

Desmopressin injections should only be used by clinicians with relevant expertise. Desmopressin is a synthetic analogue of the antidiuretic hormone vasopressin. When administered in high doses it can release factor VIII (FVIII) and von Willebrand factor (vWF) from endothelial storage sites with a three to five-fold rise in plasma FVIII coagulant activity (FVIII:C) and a three to four-fold rise in vWF level. Desmopressin has also been shown to lead to improvement in, or normalisation of, assays of platelet function, including the bleeding time, in patients with uraemia, liver cirrhosis, congenital or substance-induced platelet dysfunction. The effect of desmopressin on FVIII:C lasts for six to eight hours while the effect on bleeding time is for a shorter period of one to three hours.

Indications for use [10] [11]:

• Shortening or normalisation of prolonged bleeding time prior to an invasive therapeutic or diagnostic operation, or for therapeutic control of bleeding in patients with prolonged bleeding time as a consequence of congenital or substance-induced thrombocyte dysfunction, uraemia, cirrhosis of the liver or in patients with prolonged bleeding time of unknown aetiology
• For the therapeutic control of bleeding and bleeding prophylaxis in connection with minor surgical procedures in patients with mild haemophilia A and von Willebrand’s disease who respond positively to a test dose. In exceptional cases, even moderate forms of the disease can be treated. Desmopressin must not be used in patients with von Willebrand’s disease type IIB
• Treatment of central diabetes insipidus and for establishing renal concentration capacity testing

For contraindications, precautions and dosage, the Medsafe data sheets should be consulted [10] [11].