■去氨加压素经常在非重度血友病A患者围手术期使用。因子(F)VIII的增加:去氨加压素使用后的C是相互高度可变的。仅在A型血友病患者的测试环境中报告了快速耐受,与第一次剂量后相比,第二次剂量后的剩余反应约为70%。
■为了研究非重度血友病A围手术期患者多次施用去氨加压素后FVIII:C反应的快速耐受。
■我们研究了DAVIDLittle和DAVD2研究的26名患者在手术前(第0天[D0])和手术后第1天(D1)和第2天()去氨加压素我们通过比较D1和D2与D0的反应来研究快速耐受。我们还评估了与较早进行的去氨加压素测试相比的D0响应的再现性。
■绝对FVIII:C增加的中位数在D0时为0.50IU/mL(0.35-0.74;n=23),在D1时为0.21IU/mL(0.14-0.28;n=17),在D2时为0.23IU/mL(0.16-0.30;n=11)。第二次给药(D1)与第一次给药(D0)相比,FVIII增加的中位数百分比为42.9%(29.2%-52.5%;n=17),第三次给药(D2)与第一次给药(D0)相比为36.4%(23.7%-46.9%;n=11)。在74%的患者中,在D0时的FVIII:C去氨加压素反应与去氨加压素测试反应相当。
■手术环境中的快速耐受比以前报道的要明显得多,FVIII:C在D1和D2为初始反应的36%至43%。我们的结果可能对监测围手术期使用去氨加压素的重复治疗具有重要意义。
UNASSIGNED: Desmopressin is frequently used perioperatively in persons with nonsevere hemophilia A. However, increase in factor (F)VIII:C after desmopressin use is interindividually highly variable.
Tachyphylaxis has only been reported in test setting for persons with hemophilia A, with a remaining response of approximately 70% after a second dose compared with that after a first dose.
UNASSIGNED: To study
tachyphylaxis of FVIII:C response after multiple administration(s) of desmopressin in perioperative persons with nonsevere hemophilia A.
UNASSIGNED: We studied FVIII:C levels after desmopressin before (day 0 [D0]) and on days 1 (D1) and 2 (D2) after surgery in 26 patients of the DAVID and Little DAVID studies. We studied
tachyphylaxis by comparing the responses at D1 and D2 with that at D0. We also assessed the reproducibility of the D0 response in comparison to an earlier performed desmopressin test.
UNASSIGNED: The median absolute FVIII:C increase was 0.50 IU/mL (0.35-0.74; n = 23) at D0, 0.21 IU/mL (0.14-0.28; n = 17) at D1, and 0.23 IU/mL (0.16-0.30; n = 11) at D2. The median percentage of FVIII increase after the second administration (D1) compared with the first (D0) was 42.9% (29.2%-52.5%; n = 17) and that of the third (D2) compared with the first (D0) was 36.4% (23.7%-46.9%; n = 11). The FVIII:C desmopressin response at D0 was comparable with the desmopressin test response in 74% of the patients.
UNASSIGNED: Tachyphylaxis in the surgical setting was considerably more pronounced than previously reported, with FVIII:C at D1 and D2 of 36% to 43% of the initial response. Our results may have important implications for monitoring repeated desmopressin treatment when used perioperatively.