Nasal Desmopressin Dosing for Nosebleed

Indications and Mechanism of Action

Desmopressin enhances platelet adherence and platelet aggregate growth on human artery subendothelium, and is primarily indicated for patients with nosebleeds who are taking platelet-inhibiting drugs or diagnosed with von Willebrand disease 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery indicates that desmopressin is recommended for patients taking platelet inhibitors who are suffering from bleeding, including intracerebral hemorrhage 1, 2, 5

The standard intravenous dose of desmopressin is 0.3 μg/kg diluted in 50 ml saline and infused over 30 minutes, as recommended by the Critical Care society 1, 2, 3

Desmopressin is not recommended for routine use in all bleeding patients, but patients most likely to benefit include those with impaired platelet function or taking platelet inhibitors, according to the Critical Care society 1, 2, 5

Desmopressin has been shown to improve platelet function in volunteers on aspirin and clopidogrel, with a moderate strength of evidence, as reported by the Critical Care society 1, 2
The combined effect of platelet concentrates followed by desmopressin administration has been advocated to enhance recovery of normal platelet function, with a low strength of evidence, according to the Critical Care society 1, 2

Desmopressin has potential adverse effects, including water retention with consecutive hyponatremia, convulsions, and particular caution is needed in elderly patients, as reported by the Haematologica society 6, 7
For severe nosebleeds, consider additional measures, such as local measures to control bleeding, appropriate reversal agents if patient is on anticoagulants, and nasal endoscopy to identify the bleeding site, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 5, 8

For nosebleeds without coagulopathy, consider topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents after bleeding is controlled, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 8
For patients on antiplatelet therapy with severe bleeding, platelet transfusion may be considered, though evidence for benefit is limited, according to the American Academy of Otolaryngology-Head and Neck Surgery and the Critical Care society 5, 9