Desmopressin is a well tolerated and convenient haemostatic
drug that can be used in a number of clinical conditions with
bleeding diathesis. It has several effects on the haemostatic system, causing endogenous release of
coagulation factor VIII,
von Willebrand factor,
tissue plasminogen activator and also increasing platelet adhesiveness and shortening bleeding time. The effect is virtually immediate and lasts for several hours. Side-effects are few and mostly mild.
Desmopressin is suitable for home use in selected patients with
bleeding diathesis. The optimal dosage is 0.3 microgram kg-1 intravenously, but the
drug may also be administered subcutaneously or intranasally. In addition to the established indications,
haemophilia A,
von Willebrand's disease and platelet dysfunction, the
drug may also be used safely in other patients with unexpected
bleeding during or after surgery. The effectiveness of general prophylactic use of
desmopressin, in order to diminish
surgical blood loss and transfusion requirements, has not been proven, except in patients with known
bleeding diathesis caused by congenital or acquired haemostatic disorders, e.g. in those taking
aspirin.