Bleeding in Uremia — A Clinical Challenge

IN this issue of the Journal, Mannucci et al. report that infusions of a synthetic derivative of antidiuretic hormone — l-deamino-8-D-arginine vasopressin (DDAVP) — shorten the prolonged bleeding time and prevent bleeding complications in patients with uremia who undergo surgical procedures.1 Administration of DDAVP resulted in a consistent post-infusion increase in all coagulant activities associated with the factor VIII molecule, as well as the appearance in the circulation of larger factor VIII:von Willebrand factor (FVIII:VWF) multimers than had been present in the resting state. The maximal shortening of the bleeding time coincided with the appearance in the plasma of . . .