Evaluation of Desmopressin for Antiplatelet Reversal in Acute Extracranial Bleeding Events

Introduction: Desmopressin (DDAVP) is a vasopressin analog and antihemophilic agent that increases
serum factor VIII and von Willebrand factor to promote platelet adhesion in the endothelium. Current guidelines recommend a single dose of intravenous (IV) DDAVP in intracranial hemorrhage (ICH) associated with aspirin, COX-1 inhibitors, or ADP receptor inhibitors, but the utility of DDAVP for antiplatelet reversal outside of ICH has not been established. The objective of this study is to evaluate the efficacy and safety of using IV DDAVP for antiplatelet reversal in acute extracranial bleeding events.


Methods: A single center, retrospective, cohort study was conducted in adult patients admitted to UMass Memorial Medical Center between October 1, 2017 to June 30, 2024 presenting with an acute extracranial bleeding event (i.e. gastrointestinal bleeding, splenic hematoma) on antiplatelet therapy. The primary outcome was hemostatic efficacy 24 hours after IV DDAVP administration. Safety outcomes include change in serum sodium level and incidence of thrombotic events during admission.


Results: Seventy-nine patients were included in this study. The primary outcome of hemostatic efficacy 24 hours after IV DDAVP was achieved in 22.4% and 61.9% of patients who did and did not receive DDAVP, respectively (p=0.0542). Both groups demonstrated hemodynamic stability 24 hours from admission. The median weight-based dose of DDAVP was 0.3 mcg/kg. The incidence of new thrombotic events during admission was low across both groups.


Conclusions: DDAVP, while well tolerated, did not significantly increase achievement of effective hemostasis when used for antiplatelet reversal in acute extracranial bleeding events.