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Desmopressin improves platelet function in uremic patients taking antiplatelet agents who require emergent invasive procedures

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Abstract

Uremia is associated with platelet dysfunction and can cause a bleeding tendency resulting in a major bleeding event after an invasive procedure or surgery that may be aggravated by antiplatelet agents. We prospectively investigated the potential of desmopressin to improve platelet dysfunction and to lower bleeding risk after emergent invasive procedures in uremic patients taking antiplatelet drugs. Twenty-three patients were enrolled with a mean age of 60.2 ± 11.7 years. Baseline blood urea nitrogen and creatinine were 70.5 ± 29.4 and 10.02 ± 4.52 mg/dL, respectively. Twenty-one patients took aspirin. All patients were infused with desmopressin before their invasive procedures, which were a central catheter insertion for emergent hemodialysis in 13 patients, percutaneous nephrostomy in 7 patients, and angiography through arm or leg vessels in 3 patients. After desmopressin infusion, both the hematocrit and platelet count were slightly decreased without changes in prothrombin time or activated partial thrombin time. Collagen/epinephrine-closure time was significantly shortened from 252.7 ± 40.7 to 144.6 ± 51.0 s (p < 0.001). There were minimal bleeding in 20 patients and mild bleeding in 3 patients. None experienced severe bleeding event or required additional intervention for bleeding control. There were no adverse events including the decrease of serum sodium concentration. In conclusion, a single infusion of desmopressin before invasive procedures in uremic patients on antiplatelet drugs appeared to be well tolerated and improved platelet dysfunction measured by collagen/epinephrine-closure time.

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References

  1. Horl WH (2010) Other blood and immune disorders in chronic kidney disease. In: Floege J, Johnson RJ, Feehally J (eds) Comprehensive clinical nephrology, 4th edn. Elsevier, St. Louis, p 959–968

  2. Remuzzi G, Galbusera M, Boccardo P (2009) Disorders on hemostasis in dialysis patients. In: Henrich WL (ed) Principles and practice of dialysis, 4th edn, p 489–498

  3. Baron TH, Kamath PS, McBane RD (2013) Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med 368:2113–2124. doi:10.1056/NEJMra1206531

    Article  CAS  PubMed  Google Scholar 

  4. Mattix H, Singh AK (1999) Is the bleeding time predictive of bleeding prior to a percutaneous renal biopsy? Curr Opin Nephrol Hypertens 8:715–718

    Article  CAS  PubMed  Google Scholar 

  5. Lee HK, Kim YJ, Jeong JU, Park JS, Chi HS, Kim SB (2010) Desmopressin improves platelet dysfunction measured by in vitro closure time in uremic patients. Nephron Clin Pract 114:c248–c252

    Article  CAS  PubMed  Google Scholar 

  6. Francis J, Francis D, Larson L, Helms E, Garcia M (1999) Can the Platelet Function Analyzer (PFA)-100 test substitute for the template bleeding time in routine clinical practice? Platelets 10:132–136. doi:10.1080/09537109976194

    Article  CAS  PubMed  Google Scholar 

  7. Zupan IP, Sabovic M, Salobir B, Ponikvar JB, Cernelc P (2003) Utility of in vitro closure time test for evaluating platelet-related primary hemostasis in dialysis patients. Am J kidney Dis Off J Natl Kidney Found 42:746–751

    Article  Google Scholar 

  8. Franchini M (2007) The use of desmopressin as a hemostatic agent: a concise review. Am J Hematol 82:731–735. doi:10.1002/ajh.20940

    Article  CAS  PubMed  Google Scholar 

  9. Manno C, Bonifati C, Torres DD, Campobasso N, Schena FP (2011) Desmopressin acetate in percutaneous ultrasound-guided kidney biopsy: a randomized controlled trial. Am J kidney Dis Off J Natl Kidney Found 57:850–855. doi:10.1053/j.ajkd.2010.12.019

    Article  CAS  Google Scholar 

  10. Mannucci PM, Remuzzi G, Pusineri F et al (1983) Deamino-8-D-arginine vasopressin shortens the bleeding time in uremia. N Engl J Med 308:8–12

    Article  CAS  PubMed  Google Scholar 

  11. Cho YU, Jang S, Park CJ, Chi HS (2008) Variables that affect platelet function analyzer-100 (PFA-100) closure times and establishment of reference intervals in Korean adults. Ann Clin Lab Sci 38:247–253

    PubMed  Google Scholar 

  12. Boccardo P, Remuzzi G, Galbusera M (2004) Platelet dysfunction in renal failure. Semin Thromb Hemost 30:579–589. doi:10.1055/s-2004-835678

    Article  CAS  PubMed  Google Scholar 

  13. Sohal AS, Gangji AS, Crowther MA, Treleaven D (2006) Uremic bleeding: pathophysiology and clinical risk factors. Thromb Res 118:417–422

    Article  CAS  PubMed  Google Scholar 

  14. Ho SJ, Gemmell R, Brighton TA (2008) Platelet function testing in uraemic patients. Hematology 13:49–58. doi:10.1179/102453308X315834

    Article  PubMed  Google Scholar 

  15. Kaw D, Malhotra D (2006) Platelet dysfunction and end-stage renal disease. Semin Dial 19:317–322

    Article  PubMed  Google Scholar 

  16. Koscielny J, von Tempelhoff GF, Ziemer S et al (2004) A practical concept for preoperative management of patients with impaired primary hemostasis. Clin Appl Thromb Hemost Off J Int Acad Clin Appl Thromb Hemost 10:155–166

    Article  Google Scholar 

  17. Podda GM, Bucciarelli P, Lussana F, Lecchi A, Cattaneo M (2007) Usefulness of PFA-100 testing in the diagnostic screening of patients with suspected abnormalities of hemostasis: comparison with the bleeding time. J Thromb Haemost JTH 5:2393–2398. doi:10.1111/j.1538-7836.2007.02752.x

    Article  CAS  PubMed  Google Scholar 

  18. Escolar G, Cases A, Vinas M et al (1999) Evaluation of acquired platelet dysfunctions in uremic and cirrhotic patients using the platelet function analyzer (PFA-100): influence of hematocrit elevation. Haematologica 84:614–619

    CAS  PubMed  Google Scholar 

  19. Crescente M, Di Castelnuovo A, Iacoviello L, Vermylen J, Cerletti C, de Gaetano G (2008) Response variability to aspirin as assessed by the platelet function analyzer (PFA)-100. A systematic review. Thromb Haemost 99:14–26. doi:10.1160/TH07-08-0530

    CAS  PubMed  Google Scholar 

  20. Schulman S (2012) Pharmacologic tools to reduce bleeding in surgery. Hematol Educ Prog Am Soc Hematol Am Soc Hematol Educ Prog 2012:517–521. doi:10.1182/asheducation-2012.1.517

    Google Scholar 

  21. Mackinnon B, Fraser E, Simpson K, Fox JG, Geddes C (2008) Is it necessary to stop antiplatelet agents before a native renal biopsy? Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc 23:3566–3570. doi:10.1093/ndt/gfn282

    CAS  Google Scholar 

  22. Campbell PG, Sen A, Yadla S, Jabbour P, Jallo J (2010) Emergency reversal of antiplatelet agents in patients presenting with an intracranial hemorrhage: a clinical review. World Neurosurg 74:279–285. doi:10.1016/j.wneu.2010.05.030

    Article  PubMed  Google Scholar 

  23. Ranucci M, Nano G, Pazzaglia A, Bianchi P, Casana R, Tealdi DG (2007) Platelet mapping and desmopressin reversal of platelet inhibition during emergency carotid endarterectomy. J Cardiothorac Vasc Anesth 21:851–854. doi:10.1053/j.jvca.2007.05.009

    Article  PubMed  Google Scholar 

  24. Leithauser B, Zielske D, Seyfert UT, Jung F (2008) Effects of desmopressin on platelet membrane glycoproteins and platelet aggregation in volunteers on clopidogrel. Clin Hemorheol Microcirc 39:293–302

    CAS  PubMed  Google Scholar 

  25. Reiter RA, Mayr F, Blazicek H et al (2003) Desmopressin antagonizes the in vitro platelet dysfunction induced by GPIIb/IIIa inhibitors and aspirin. Blood 102:4594–4599. doi:10.1182/blood-2002-11-3566

    Article  CAS  PubMed  Google Scholar 

  26. Livio M, Benigni A, Vigano G, Mecca G, Remuzzi G (1986) Moderate doses of aspirin and risk of bleeding in renal failure. Lancet 1:414–416

    Article  CAS  PubMed  Google Scholar 

  27. Kaufman JS, O’Connor TZ, Zhang JH et al (2003) Randomized controlled trial of clopidogrel plus aspirin to prevent hemodialysis access graft thrombosis. J Am Soc Nephrol JASN 14:2313–2321

    Article  CAS  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Ji Hyun Kim, Chung Hee Baek, Ji Yeon Min, Joon-Seok Kim, Soon Bae Kim & Hyosang Kim

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  1. Ji Hyun Kim
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  2. Chung Hee Baek
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  3. Ji Yeon Min
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  4. Joon-Seok Kim
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  5. Soon Bae Kim
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  6. Hyosang Kim
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Correspondence to Hyosang Kim.

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Kim, J.H., Baek, C.H., Min, J.Y. et al. Desmopressin improves platelet function in uremic patients taking antiplatelet agents who require emergent invasive procedures. Ann Hematol 94, 1457–1461 (2015). https://doi.org/10.1007/s00277-015-2384-1

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  • DOI: https://doi.org/10.1007/s00277-015-2384-1

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