Role of Desmopressin in Bleeding Disorders: What Indian Physicians Need to Know?

Desmopressin (1-deamino-8-D-arginine vasopressin), formerly introduced for the treatment of diabetes insipidus, is a well-known analog of vasopressin, that is, antidiuretic hormone (ADH). Subsequently, after the late 1970s, it has emerged as the medication of choice for type 1 von Willebrand's disease (vWD) and minor hemophilia A. Prothrombotic factors FVIII and von Willebrand factor (vWF) are released from storage sites when vasopressin receptors are targeted by desmopressin. It also facilitates platelet-vessel wall adhesion, resulting in a substantial hemostatic effect. Research studies have shown that desmopressin administration can lead to up to a fourfold increase in vWF levels, highlighting its hemostatic actions. Desmopressin is commonly used in conditions like nocturnal polyuria leading to nocturia or nocturnal enuresis, diabetes insipidus, von Willebrand disease, uremic bleeding, and hemophilia A. Desmopressin is also used to avoid rapid sodium correction along with hypertonic saline, management of intracranial bleed due to the use of antiplatelet agents, and trauma resuscitation with active hemorrhage. It is also used in bleeding disorders, dental extractions, epistaxis, and menstrual bleeding. Hence, it is imperative that clinicians become acquainted with the use of desmopressin, which has become a common medication for many patients with congenital bleeding disorders. Desmopressin is included in the treatment guidelines for vWD.