Comparison of Two Weight-Based Desmopressin Dosing Strategies for Spontaneous Bleeding

Abstract

Background: The pharmacokinetics and pharmacodynamics of desmopressin are appropriate for adjusted body weight–based dosing, particularly in obese patients. Objective: The objective of this study was to describe desmopressin dosing strategies, with emphasis on hemostatic outcomes among patients without preexisting bleeding disorders. Methods: This was a single-center, retrospective cohort study of patients who received intravenous weight-based desmopressin for a hemostatic indication. Demographics, comorbidities, treatment setting, indication, site of bleeding, and outcomes were collected from the medical record. Primary outcomes included need for procedural intervention to achieve hemostasis, transfusion requirement, and death. Association between desmopressin dose and outcome was evaluated using χ2 or Fischer’s exact tests and logistic and linear regression models. Multiple regression analysis was conducted to identify other predictors of outcome in the data set. Results: A total of 109 patients were included (n = 26, dose adjustment; n = 83, no dose adjustment). Baseline characteristics were well-matched between groups: mean (SD) age of 57.0 (13.5) years; mean (SD) Charlson Comorbidity Score of 6.5 (2.8); 37% were obese; 76% were critically ill; 81% were actively bleeding without differences in site of bleeding; and crude mortality was 39%. No differences in death, mean units of packed red blood cells transfused, or need for procedural hemostasis were observed between adjusted weight– and actual weight–based desmopressin dosing. Conclusions: When used adjunctively to blood product transfusion in actively bleeding patients, use of adjusted body weight–based desmopressin did not negatively affect clinical outcomes. More data are needed to confirm this dosing strategy.