Stimate® / DDAVP Challenge

What are DDAVP and Stimate®

DDAVP is a medicine that can help stop bleeding in patients with von Willebrand disease. It can sometimes be used for patients with mild or moderate Hemophilia A. Your child might receive the medicine through an IV, or a nose spray called Stimate®.

How the medicines work

Von Willebrand factor is a protein in the blood. It acts like glue with the body’s platelets to help blood form a clot to stop bleeding.

Some patients with von Willebrand disease do not have enough von Willebrand factor. Other patients have enough von Willebrand factor, but it does not work properly.

The factor is stored in the platelets of the blood. It is also in the cells that line the blood vessels.

Stimate helps to release the factor from where it is stored. That can mean it is ready to be used in the body to stop bleeding.

DDAVP/Stimate challenge

DDAVP/Stimate may not work for everyone. Your child’s care team might recommend a Stimate challenge (test) to make sure it will help your child stop bleeding. If it works, you can use it before your child has dental work or minor surgeries. It can also help with some bleeding episodes.

You should always talk to your child’s care team before your child has any procedure that involves cutting the skin.

What to expect

This test will be scheduled at a medical facility.

A member of your child’s care team will take a blood sample with a small needle. The lab will check for:

• von Willebrand factor antigen and activity levels
• Factor VIII level
• Platelet count

An IV may need to stay in place until all labs are verified as good quality.

DDAVP comes as either an IV medicine or a nasal spray.

If your child is using the nasal form, your child should blow their nose first then “sniff” the medicine up their nose. Your care team will let you and your child know how many “sniffs” they should take.

After you are given the medicine, you will wait about an hour. Then, the nurse will take another blood sample to check the same blood levels.

Sometimes the nurse will use the IV. Other times, a new sample is needed with a fresh needle stick. In some cases, a third blood sample will be collected 4 hours after your child takes the medicine.

A member of your child’s care team will let you know the results. It may take 1-2 weeks. Ask your child’s care team when to expect results.

If you are sent home with extra Stimate, do not let your child take it until you hear from the care team.

Results of the test

Three possible results can come from a DDAVP/Stimate challenge:

• The DDAVP/Stimate did not increase the levels of von Willebrand factor and Factor VIII. This means it will not help stop bleeding in your child and cannot be used.
• The DDAVP/Stimate caused an increase in the von Willebrand factor levels and Factor VIII. If this happens, the care team will call you and tell you how your child should use Stimate.
• DDAVP/Stimate may not raise the levels enough for surgeries or life-threatening bleeding, but it could be used for minor bleeding. Your child’s care team will talk to you about what this means.