Desamino-D-arginine vasopressin and bleeding time in von Willebrand's disease

We report the case of a 26-year-old man with mild von Willebrand's disease with a baseline level factor VIII of 8% to 11% and a bleeding time grater than 15 minutes. We believe this is a unique case, in which the reported tachyphylaxis phenomenon by which most patients become refractory to desamino-D-arginine vasopressin after a maximum of 4 to 5 days after starting treatment did not occur throughout the entire postoperative course. The unexpected success of this therapeutic program with the additional benefit of no need for plasma product with its accompanying hazards, as well as financial savings ($6600 for required cryoprecipitate as opposed to $1100 for desamino-D-arginine vasopressin) makes it a promising approach to the surgical management of patients with mild von Willebrand's disease. This application warrants further study.