Desmopressin in Bleeding Disorders

Before the introduction of DDA VP, centrnl diabetes insipidus was treated by the administration of a more or less purified extract from bovine or porcine posterior pituitaries, and the prepamtions were mostly given in the form of nasal snuff. In 1956, the structure of vasopressin became known and two forms were found, namely arginine vasopressin (A VP) in humans and most other species, and lysine vasopressin (L VP) which was found in the pig. In 1967, Zaornl et al. were the frrst to synthesize l-desamino-8-D-arginine vasopressin, DDA VP. In comparison with the compounds which were previously available, DDA VP offered increased antidiuretic potency and an equally distinct shift of the antidiuretic to pressor potency rntio. As a result of the pioneering studies of Cash and Mannucci, numerous publications appeared in the medical literature of the 80's, widening the fields of clinical application of the drug. A very important aspect of this drug is that it can be used as an alternative treatment for mild factor VllI deficiencies, mild hemophilia A and von Willebrnnd's disease. These congenital deficiencies are far from mre and have, up to now, been treated with plasma-derived factor VIII concentrates; in the countries in which desmopressin has not been used a consistent proportion of these patients have seroconverted for HIV 1 and hepatitis.

Klappentext

Proceedings of a NATO ARW held in Il Ciocco, Tuscany, Italy, April 27-30, 1992

Zusammenfassung
Proceedings of a NATO ARW held in Il Ciocco, Tuscany, Italy, April 27-30, 1992

Inhalt
I. Hemostasis and Desmopressin.- Regulation of Haemostasis: The Role of Arginine Vasopressin.- Von Willebrand Factor and P-Selectin Targeting to and Release from Endothelial Cell-Specific Storage Granules.- Factor VIII in Monkeys, Effect of DDAVP Analogues.- Possible Involvement of Serotonin in the Haemostatic Action of DDAVP in Patients with Uraemia.- Molecular Mechanisms of Cellular Responses to DDAVP.- II. Phemacology and Pharmacodynamics of Desmopressin.- Some Pharmacological Properties of Desmopressin.- Pharmacokinetics of Desmopressin.- Fall-Off of Factor VIII Elicited by Desmopressin Administration in Hemophiliacs and von Willebrand's Disease Patients.- Toxicity of Desmopressin and Related Peptides.- The Hemodynamic and Coagulant Effects of dDAVP are Specific Extrarenal V2-Receptor Responses.- The Vasopressin Antagonist SK&F 105494 Inhibits Desmopressin-Stimulated Clotting Factor Release in vivo.- Non-Responsivess of t-PA, u-PA, and vWF to DDAVP.- III. Desmopressin in Renal Disease.- Control of Bleeding in Uremic Patients.- Hemostatic Effectiveness of Desmopressin in the Bleeding Disorders of Uremia.- Renal Function and Thromboembolism in High Dose Desmopressin Treatment.- IV. Desmopressin and Platelets.- DDAVP Corrects the Platelet Dysfunction Produced by Cardiopulmonary By-Pass, Hemodialysis and Prolonged Storage: Re-Expresion of Glycoprotein Ib on the Platelet Membrane.- Desmopressin in the Treatment of Congenital and Acquired Defects of Platelet Functions.- The Effectiveness of Desmopressin in Patients with Disorders of Primary Haemostasis.- Clinical Efficacy of Desmopressin and Consistency of Responses to Separate Infusion in Patients with Prolonged Bleeding Time Due to Congenital Platelet Defect.- V. Desmopressin and Surgery.- Desmopressin, von WillebrandFactor and Surgery.- Desmopressin in Cardiac Surgery with Extra-Corporeal Circulation.- Desmopressin Corrects the Hemostatic Disorder Induced by Dextran and Regional Anesthesia in Total Hip Replacement.- VI. Desmopressin and Blood Donation.- Effects of Desmopressin on Normal Donors in Plasma Exchange Donations.- The Use of DDAVP in Blood Donors to Increase the Yield of Factor VIII in the Preparation of Factor VIII Concentrates.- VII Clinical Applications of Desmopressin in Hemophilia and von Willebrand's Disease.- Epidemiology of Mild and Moderate Hemophilia A and von Willebrand's Disease.- An Overview of Gene Alterations in Mild Hemophilia and von Willebrand Disease.- DDAVP Clinical Use and Therapeutic Limitations in Patients with Congential Bleeding Disorders: The Auckland Experience.- Multicenter Evaluation of a New Concentrated Desmopressin Preparation (Emosint) Administered Intravenously or Subcutaneously: Analysis of Biological Responses and Side-Effects in 49 Patients with Hemophilia A and von Willebrand's Disease.- Management of Spontaneous Bleeding and Prevention of Bleeding after Dental Extractions and Other Surgical Procedures in Mild Hemophilia A and von Willebrand's Disease: Ten Years of Experience at the Vicenza Hemophilia and Thrombosis Center.- Multicenter Italian Study on Subcutaneous Concentrated Desmopressin (Emosint) for the In-Hospital and Home Treatment of Patients with von Willebrand Disease and Mild or Moderate Hemophilia A: Outline of the Project.- Desmopressin: An Overview of Present and Future Indications with a Review of Investigations Performed at the University of Manitoba, 19811989.- VIII. Clinical Applications of Desmopressin in Hemophilia and von Willebrand's Disease (Second Part).- Desmopressin in Acquired Hemophilia.-Intravenous and Subcutaneous Desmopressin: Clinical Results.- Intranasal Application of DDAVP: Biological Function, Pharmacokinetics and Reproducibility.- Use of Highly Concentrated Intranasal Spray Formulation of Desmopressin in Persons with Congenital Bleeding Disorders.- Nasal Spray Desmopressin: Laboratory and Clinical Implications.- IX. Side-Effects and Adverse Reactions of Desmopressin.- DDAVP and Tachyphylaxis in Healthy Subjects.- Biological Responses to Repeated Doses of Desmopressin (DDAVP) in Patients with Hemophilia and von Willebrand's Disease.- Myocardial Infarction and Stroke: Is the Risk Increased by Desmopressin?.- X. Recapitulation.- DDAVP in the Management of Congential and Acquired Bleeding Disorders: Solved and Unsolved Issues.