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Thromb Haemost 1982; 48(02): 156-161
DOI: 10.1055/s-0038-1657246
Original Article
Schattauer GmbH Stuttgart

The Use of Desmopressin Acetate (DDAVP) as a Test of the Fibrinolytic Capacity of Patients – Analysis of Responders and Non-Responders

E J P Brommer
The Gaubius Institute, Health Research Division TNO, Leiden, The Netherlands
,
M M Barrett-Bergshoeff
The Gaubius Institute, Health Research Division TNO, Leiden, The Netherlands
,
R A Allen
The Gaubius Institute, Health Research Division TNO, Leiden, The Netherlands
,
I Schicht
*   The Dept. of Nephrology, Academic Hospital, Leiden, The Netherlands
,
R M Bertina
**   The Dept. of Haematology, Academic Hospital, Leiden, The Netherlands
,
M A D H Schalekamp
***   The Dept. of Internal Medicine I, Erasmus University, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Received 15 March 1982

Accepted 02 August 1982

Publication Date:
13 July 2018 (online)

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Summary

Intravenous infusion of desmopressin (DDAVP, 0.4 μg/kg b.w. in 12’) causes an increase in the level of extrinsic plasminogen activator, measured in plasma euglobulin fractions with added C1-inactivator on fibrin plates. A poor response or no response at all was elicited in two out of 21 patients with spontaneous thrombosis, 18/38 with hyperlipoproteinaemia and 10/14 with terminal renal insufficiency requiring haemodialysis.

Haemodilution during the first 30’ after starting the DDAVP-infusion occurred both in responders and in non-responders; so did haemodynamic reactions: increase in heart rate, drop in diastolic blood pressure, facial flushing. The rise of fibrinolytic activity was shown not to be associated with decreased hepatic blood flow. Normal factor VIII-rises in “non-responders” indicate the responsiveness of the receptive organs, including the hypothalamus, to DDAVP.

Despite a normal baseline level of fibrinolytic activity in the blood, as occurs for instance in terminal renal insufficiency, the vascular endothelium may be refractory to stimulation. In some patients, especially in type IV hyperlipoproteinaemia, a selective defect of the release of plasminogen activator is postulated. In subjects with low fibrinolytic activity at rest, as observed in spontaneous thromboembolism and in hypertriglyceridaemia, the failure to release plasminogen activator upon stimulation with DDAVP might be a consequence of an impairment of synthesis as well.

Keywords

DDAVP - Fibrinolytic activity - Hepatic blood flow - Factor VIIIR:Ag - Extrinsic plasminogen activator