Abstract Number: LPB0067
Meeting: ISTH 2021 Congress
Background: Non-severe hemophilia A patients can peri-operatively be treated with desmopressin or factor VIII (FVIII) concentrate. Desmopressin increases FVIII levels which if sufficient can be used for (minor) procedures. Data is limited on tachyphylaxis, a decreased response after repeated desmopressin administration.
Aims: To study desmopressin response in hemophilia A patients after repeated peri-operative daily doses of desmopressin and to investigate extent of tachyphylaxis.
Methods: Hemophilia A patients responsive to desmopressin undergoing a (minor) procedure were included. Historical results from a desmopressin test administration were collected from patients’ medical files. Desmopressin was administered once-a-day intravenously (0.3 µg/kg) in 30 minutes on day of surgery (D0) and maximally two days onwards (D1 and D2). Blood samples were collected before start and +/- ca. 20-30 minutes after end of infusion. The FVIII increase was calculated as the difference between the FVIII level before and after desmopressin on the respective day. Response to repeated desmopressin administration (tachyphylaxis) between consecutive days and comparison between D0 and desmopressin test was calculated as a percentage, dividing latter and earlier mentioned FVIII increases with each other. Local ethics committee approval was obtained and patients provided written informed consent.
Results: Patient characteristics and treatment days of 21 procedures are described in table 1. Figure 2 shows the increase of FVIII after desmopressin test and treatment. Median percentage of tachyphylaxis was: D1/D0 42.9% (n = 19; IQR 31.1% – 51.9%), D2/D0 33.3% (n = 12; IQR 23.2% – 46.3%) and 88.5% (n = 12; IQR 66.4% – 109.1%) D2/D1. Median percentage of desmopressin test/D0 was 95% (n = 21; IQR 81.8% – 135.2%).
|Characteristic||Number (%) / median [interquartile range]|
|Lowest FVIII level (IU/ml)||0.15 [0.08 – 0.19]|
|Consecutive days desmopressin
Conclusions: Repeated daily desmopressin administration in the peri-operative setting results in a drastic decrease of more than 50% in FVIII response, especially when comparing first with second desmopressin administration. Desmopressin test response predicted the response to the first pre-operative desmopressin administration accurately.
To cite this abstract in AMA style:Romano LGR, Schütte LM, van Hest RM, Meijer K, Laros - van Gorkom BAP, Nieuwenhuizen L, Eikenboom J, Heubel-Moenen FCJI, Uitslager N, Coppens M, Fijnvandraat K, Driessens MHE, Polinder S, Cnossen MH, Leebeek FWG, Mahtôt RAA, Kruip MJHA, On behalf of the SYMPHONY Consortium . Drastic Decrease in FVIII Response after Repeated Daily Desmopressin Administrations in Peri-operative Non-severe Hemophilia A Patients: Final Results of Tachyphylaxis in the DAVID and Little DAVID Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/drastic-decrease-in-fviii-response-after-repeated-daily-desmopressin-administrations-in-peri-operative-non-severe-hemophilia-a-patients-final-results-of-tachyphylaxis-in-the-david-and-little-david-st/. Accessed November 30, 2021.
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