Good afternoon, comrades. I would like to ask a question regarding chronic Desmopressin treatments and VonWillebrand Factor (VWF) release.

Desmopressin is a drug used to control diabetes insipidus, sometimes for weeks, as well as in patients with VWF deficiency who must undergo surgery, in which it is almost used to promote the release of this factor to ensure correct coagulation of the face to possible surgical bleeding complications.

Article Role of von Willebrand factor in the haemostasis

"Plasma VWF exists as a multimers of various sizes, the largest VWF multimers are usually contained in storage granules and are not seen in the blood of normal people. Ultra-large VWF multimers can be detected in normal plasma only transiently, after induction of secretion from endothelial cells with the therapeutic agent I-deamino-δ-D-arginine vasopressin (DDAVP)40 or in diseases such as thrombotic thrombocytopenic purpura (TTP)/haemolytic uraemic syndrome. Ultra-large VWF multimers are hyperactive in binding the platelet receptor GPIb-IX-V complex, which results in spontaneous platelet aggregation41. Because of this prothrombotic property, ultra-large VWF should be quickly removed from the plasma of healthy individuals23. The regulation of plasma VWF size occurs by specific proteolytic process by the metalloprotease ADAMTS-1342."

"Haemostasis depends on the balanced participation of VWF, and this balance reflects a competition between the biosynthesis of large VWF multimers and their degradation by the ADAMTS-13 metalloprotease. Severe deficiency of ADAMTS-13 activity may cause thrombotic thrombocytopenic purpura (TTP), a life-threatening haematological disease associated with extensive platelet- and VWF-rich thrombus formation"

In this case, I would like to know if anyone has information about what happens with the production of the largest VWF multimers, after the onset of a desmopressine treatment or if there is a overexpression of ADAMTS-13 metalloprotease, because in the article they comment that it is observed only a temporary release, but no further explanation is given.

Article How do you treat bleeding disorders with desmopressin?

" A rare but serious side effect in patients receiving desmopressin is the occurrence of arterial thrombotic events, such as stroke or acute myocardial infarction.21,22 Caution should be exercised, therefore, with the use of desmopressin in elderly patients with atherosclerotic disease. Venous thrombosis is likewise rare after desmopressin administration, and has been observed only in patients who had received desmopressin after transfusion of FVIII/VWF concentrates."

Knowing that an acute thrombotic arterial phenomenon can occur, in what way could a possible state of associated transient hypercoagulability be monitored to evaluate a possible heparin-based treatment?

Thank you very much, I hope someone can shed some light on it.