Desmopressin as a Treatment Attempt

For endoscopic interventions, recommendations exist on how to administer oral anticoagulants and thrombocyte aggregation inhibitors. Unfortunately the authors did not mention administering desmopressin to prevent hemorrhages or rapidly achieve hemostasis, and neither did they mention local hemostasis by using cyclokapron solution (1). Before administering highly concentrated platelets after hemorrhage during an urgent operation, preceding which it was not possible to stop treatment with platelet aggregation inhibitors, a treatment attempt should be undertaken using desmopressin (0.3 µg/kg body weight as a brief i.v. infusion administered over 30 minutes) (2). Locally, hemostasis can be achieved by applying a gauze pad soaked in cyclokapron solution, for example, if a tissue specimen was taken (3).

Hemorrhages in patients receiving vitamin K antagonists or direct anticoagulants can be stopped immediately by administering a complex consisting of prothrombin, proconvertin (factor VII), Stuart–Prower factor (factor X), and antihemophilic globulin B (PPSB) or activated PPSB complex. If the treatment with direct anticoagulants can be stopped before the procedure, concentrations should be lower than 30 μg/L in order to prevent intensified bleeds. If the risk of thrombosis is high—especially during an episode of Crohn’s disease or ulcerative colitis—effective anticoagulation treatment will have to be initiated 6 hours after the procedure, for example, overlapping with heparin and vitamin K antagonists or direct anticoagulants.