Easy bruisability, aspirin intolerance, and response to DDAVP®

Easy bruisability raises the issue of bleeding during otolaryngological surgery. Ten female patients with easy bruisability were evaluated by aspirin challenge; clinical history and screening coagulation studies in these patients had revealed no evidence of a bleeding disorder. The baseline Ivy bleeding time (BT) test (4.5 to 9.5 minutes) was found to be normal in 6 patients and prolonged in 4 patients. Following treatment with aspirin, the bleeding time prolonged significantly in the three groups evaluated: normal controls (6.0 +/- 1.5 minutes vs. 8.4 +/- 2.0 minutes), patients with easy bruisability and a normal baseline (7.8 +/- 1.3 minutes vs. 12.0 +/- 1.6 minutes), and patients with easy bruisability and an abnormal baseline (11.0 +/- 0.7 minutes vs. 14.5 +/- 0.9 minutes). Administration of DDAVP (desmopressin acetate) 0.3 microgram/kg normalized the prolonged bleeding times in all groups after 7 days of daily aspirin therapy. Performing bleeding times before aspirin challenge, after aspirin challenge, and after DDAVP therapy following aspirin challenge is both a useful way of confirming aspirin sensitivity in patients with easy bruisability as well as a useful way of documenting improved hemostasis after DDAVP administration.