抄録
As desmopressin (DDAVP) has gained wide acceptance as the first choice treatment in perioperative management of patients with von Willebrand disease (vWD) type I, DDAVP was administered 30min prior to total thyroidectomy of a vWD patient.
Response of factor VIII coagulant activity (VIIIc) and ristocetin cofactor (RcoF) to DDAVP was slow and the maximum levels were obtained 6 hours after infusion (VIIIc: 0.48 to 2.05U/ml and RcoF: 0.44 to 0.98U/ml). VIIIc and RcoF returned to the preinfusion level 48 hours and 4 days after DDAVP administration, respectively. No further DDAVP was necessary because of this prolonged response and no remarkable postoperative hemorrhage.
Response to the second DDAVP administration, performed at the removal of drain tubes, 7 days after the surgery, showed almost identical elevation of both activities (increased range, VIIIc: 2-fold and RcoF: 2.7-fold). VIIIc returned to the preinfusion level after 18 hours and RcoF activity showed still high level at that time.
The delayed and prolonged response of these factors to DDAVP during the surgery would be derived from the effect of the surgical procedures and the anesthesia.
