Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders

Review question

We reviewed the evidence about the effect and safety of desmopressin acetate in preventing and treating acute bleeding in pregnant woman with bleeding disorders.

Background

Congenital bleeding disorders cause problems with bleeding during pregnancy, labour and delivery. Bleeding complications in women with congenital bleeding disorders are an important cause of disease and death linked to childbirth. Agents to stop the flow of blood are used for women with these bleeding disorders during pregnancy. Desmopressin acetate is a drug used to effectively increase the concentration of factor VIII in the blood and to increase the clumping together of platelets to stop bleeding. It does not come from human plasma and it carries no risk of infection. It might be a precious resource in people with von Willebrand disease, haemophilia A or congenital platelet disorders to prevent and treat bleeding episodes related to pregnancy.

Search date

The evidence is current to: 18 June 2015.

Study characteristics

We did not find any randomised controlled trials assessing desmopressin acetate in this group of women.

Key results

There were no trials included in the review. Given the ethical considerations, future randomised controlled trials are unlikely. Evidence is needed to show the risks and benefits of desmopressin acetate when used to prevent and treat bleeding during pregnancy in women with congenital bleeding disorders. While there is evidence from observational trials that shows the drug is effective in stopping and preventing bleeding, we conclude that there is still a need to generate other high quality controlled evidence.

Authors' conclusions: 

The review did not identify any randomised controlled trials investigating the relative effectiveness of desmopressin acetate for bleeding during pregnancy in women with congenital bleeding disorders. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials) to decide whether or not to treat women with congenital bleeding disorders with desmopressin acetate.

Given the ethical considerations, future randomised controlled trials are unlikely. However, other high quality controlled studies (such as risk allocation designs, sequential design, parallel cohort design) to investigate the risks and benefits of using desmopressin acetate in this population are needed.

Read the full abstract...
Background: 

Congenital bleeding disorders can cause obstetric haemorrhage during pregnancy, labour and following delivery. Desmopressin acetate is found to be an effective drug which can reduce the risk of haemorrhage and can also stop bleeding in certain congenital bleeding disorders. Its use in pregnancy has been controversial. Hence beneficial and adverse effects of desmopressin acetate in these groups of pregnant women should be evaluated.

This is an update of a Cochrane review first published in 2013.

Objectives: 

To determine the efficacy of desmopressin acetate in preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders.

Search strategy: 

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coaguopathies Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant and abstract books of conferences proceedings. We also searched for any randomised controlled trials in a registry of ongoing trials and the reference lists of relevant articles and reviews.

Date of most recent search: 18 June 2015.

Selection criteria: 

Randomised and quasi-randomised controlled trials investigating the efficacy of desmopressin acetate versus tranexamic acid or factor VIII or rFactor VII or fresh frozen plasma in preventing and treating congenital bleeding disorders during pregnancy were eligible.

Data collection and analysis: 

No trials matching the selection criteria were eligible for inclusion.

Main results: 

No trials matching the selection criteria were eligible for inclusion.

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