Desmopressin During Operations Reduces Factor VIII Use in Hemophilia A

The combination of desmopressin and pharmacokinetic-guided factor VIII (FVIII) concentrate during operations was reportedly feasible and safe in patients with nonsevere hemophilia A, according to a study published in Haemophilia.

“This novel approach may result in considerable FVIII concentrate savings in non-severe hemophilia patients undergoing medical procedures,” wrote the study’s lead author, Lorenzo Romano, MD, from Erasmus University Medical Center in Rotterdam, Netherlands.

Desmopressin Optimizes Hemophilia A Treatment

The analysis covered 33 procedures among 32 patients with nonsevere hemophilia A responsive to desmopressin from two studies, DAVID (n=21) and Little DAVID (n=12). DAVID evaluated intravenous desmopressin 0.3 μg/kg followed by FVIII concentrate for up to three consecutive days. Little DAVID compared the combination treatment and FVIII concentrate alone for up to two days.

In DAVID, 73.7% and 76.5% of FVIII:C trough levels were predicted accurately on day one and day two, respectively, and peak FVIII:C level predictions on day zero were accurate in 61.9% of cases. In Little DAVID, 83.3% of FVIII:C peak levels across both groups were accurately predicted on day zero.

Notably, the combination therapy reduced the use of preoperative FVIII concentrate by 47% compared with FVIII monotherapy. Two bleeding events occurred, though the authors noted that FVIII:C was greater than 1.00 IU/mL for both. Desmopressin side effects were described as “mild and transient.”

“Perioperative [pharmacokinetic] guided combination treatment of desmopressin and FVIII concentrate in nonsevere hemophilia A is feasible and safe,” Dr. Romano and colleagues concluded.

Reference

Romano LGR, Schütte LM, van Hest RM, et al. Peri-operative desmopressin combined with pharmacokinetic-guided factor VIII concentrate in non-severe haemophilia A patients. Haemophilia. 2024. doi:10.1111/hae.14946