DDAVP : A New Pharmacologic Approach to the Management of Hemophilia and Von Willebrand’s Disease

I-deamino – 8 D – arginine (DDAVP) infusion causes a marked increase of F VIII – related properties in patients with moderate and mild hemophilia (H) and von Willebrand’s disease (VWD) The possibility was evaluated that such an autologous F VIII response might be hemostatically effective, allowing patients (pts) to undergo surgery without blood products. 0.3 μ/Kg of DDAVP given before dental surgery and repeated in the early post–operative period were followed by a 2 – to 3 fold rise of F VIII coagulant activity (VIII : C) in 4 pts with moderate and mild H. In two, there was no abnormal bleeding after dental extraction, whereas plasma concentrates became necessary to control oozing in the remaining 2 pts. The adoption of higher dosage (0.4–0.5 μ/Kg) in pts with higher starting VIII : C (9% or more) was followed by a more marked response (4 to 6 fold). Hence, VIII : C levels up to 100% of average normal could be achieved and dental extractions as well as major surgical procedures (such as cholecystectomy, thoracotomy and two tonsillectomies) were carried out successfully in 6 pts with mild H and 2 with VWD. The mean halfdisappearance time of autologous VIII : C was 9.4 hours (range 7.5–11.6). Plasma and urine osmolality showed no consistent variation. DDAVP appears a promising pharmacologic alternative to plasma concentrates in the management of a number of pts with H and VWD.