Desmopressin in cases of compromised primary hemostasis: monitoring of platelet function with the PFA-100

Disorders of primary hemostasis are a greater diagnostical and therapeutica l problem than plasmatic coagulation disturbances. The Simplate bleeding ti me (BT) is rather unreliable to detect them. The efficacy of therapeutic me asures can only poorly be estimated in the individual case, especially when hemostatic drugs instead of blood products are used. Disorders of primary hemostasis could be easily detected by means of the PFA-100 using the epine phrine test (PFA-EPI). Additionally, the PFA-100 allows monitoring of the t herapeutic effect of desmopressin. The PFA-EPI showed clearly higher sensit ivity than the BT to detect von Willebrand disease which is the most freque nt congenital disorder of primary hemostasis. Low dose therapy with ASS (si ngle dose of 100 mg) mostly does not prolong ET, however was detectable 4 a nd 12 hours after ingestion by PFA-EPI in 50 % of the cases. Various disord ers of primary hemostasis (congenital and acquired vWD, storage pool defici ency, ASS-induced platelet dysfunction, mild thrombocytopenia, thrombocyte dysfunction of unknown aetiology) could be successfully treated by desmopre ssin, Perioperative bleeding complications could be prevented when the ther apeutic efficacy was demonstrable by PFA-100 (PFA-EPI and/or PFA-ADP). This was mostly the case. However, PFA-100 needs to be further developed. For i ts present useful routine application special methodical aspects have to be followed.