Reversal of thienopyridine-induced platelet dysfunction following desmopressin administration

J Med Toxicol. 2013 Jun;9(2):139-43. doi: 10.1007/s13181-012-0275-6.

Abstract

Adenosine diphosphate (ADP)-receptor antagonists are widely used for thrombus prevention, although reversing their platelet dysfunction is difficult. This study evaluated the ability of desmopressin to reverse clopidogrel-induced platelet dysfunction. Sprague-Dawley rats received either clopidogrel (30 mg/kg) or placebo, followed 4 h later by saline or desmopressin (0.15, 0.3, or 0.6 μg/kg). Bleeding times and platelet aggregation studies were subsequently performed. A bleeding time >25 min was considered "prolonged." The median bleeding time for clopidogrel-exposed rats was 21 min, vs. 6 min for controls (p < 0.01). Progressively higher doses of 1-deamino-8-D-arginine vasopressin (DDAVP) were associated with a reduced number of rats with prolonged bleeding time (p = 0.001). Higher doses of DDAVP were also associated with a reduction in the median (IQR) bleeding time; 29 (13.5-30) min in rats receiving clopidogrel without DDAVP vs. 19 (12-28) min in rats receiving clopidogrel and 0.6 μg/kg DDAVP. The step-wise dosing of DDAVP resulted in a 54 % reduction in meeting the endpoint of prolonged bleeding time (OR 0.46; p = 0.025; 95 % CI 0.23-0.91). Platelet aggregation was observed in all control rats, but only some of those clopidogrel-treated rats who received 0.6 μg/kg DDAVP. In this model of an ADP-receptor antagonist, DDAVP results in partial reversal of clopidogrel-induced platelet dysfunction.

MeSH terms

  • Animals
  • Antidiuretic Agents / administration & dosage
  • Antidiuretic Agents / therapeutic use
  • Bleeding Time
  • Clopidogrel
  • Deamino Arginine Vasopressin / administration & dosage
  • Deamino Arginine Vasopressin / therapeutic use*
  • Disease Models, Animal
  • Dose-Response Relationship, Drug
  • Drug Overdose / blood
  • Drug Overdose / drug therapy*
  • Hemostatics / administration & dosage
  • Hemostatics / therapeutic use*
  • Injections, Intravenous
  • Male
  • Platelet Aggregation / drug effects*
  • Platelet Aggregation Inhibitors / poisoning
  • Prodrugs / poisoning*
  • Purinergic P2Y Receptor Antagonists / poisoning*
  • Pyridines / chemistry
  • Pyridines / poisoning
  • Random Allocation
  • Rats
  • Rats, Sprague-Dawley
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / poisoning

Substances

  • Antidiuretic Agents
  • Hemostatics
  • Platelet Aggregation Inhibitors
  • Prodrugs
  • Purinergic P2Y Receptor Antagonists
  • Pyridines
  • thienopyridine
  • Clopidogrel
  • Deamino Arginine Vasopressin
  • Ticlopidine