Haemostasis and beyond: The expanding role of desmopressin in intensive care

Core Tip

Core Tip: In recent years, desmopressin has emerged as a potentially valuable agent in managing complex scenarios such as uremic platelet dysfunction, trauma-associated coagulopathy, intracranial hemorrhage, von Willebrand disease, and central diabetes insipidus. These conditions may be particularly challenging to manage, especially in critically ill patients. Emerging evidence suggests that desmopressin use may improve surrogate outcomes such as bleeding time and transfusion reduction. However, its impact on long-term clinical outcomes remains under investigation. The primary safety concern is hyponatremia due to water retention, which necessitates proactive fluid restriction and electrolyte monitoring. Thrombotic risk is low but warrants caution in high-risk patients. Despite its increasing application in intensive care units, desmopressin use remains largely empirical in many of these off-label contexts. This is because there is no universally accepted guidance on optimal dosing strategies, timing of administration, or patient selection.