Highlights
- •This study sought to analyze the safety and efficacy of DDAVP in patients with antiplatelet-associated ICH.
- •Primary outcome of hematoma expansion incidence was determined by review of CT scans within 24 hours of the baseline scan.
- •Administration of DDAVP did not reduce incidence of hematoma volume expansion in patients with antiplatelet-associated ICH.
- •Future prospective randomized controlled studies are needed to evaluate the efficacy of DDAVP in antiplatelet associated ICH.
Abstract
Introduction
Antiplatelet medications interfere with hemostasis which can contribute to increased
risk of hematoma expansion and potentially worse outcomes in patients presenting with
intracranial hemorrhages (ICH). Current Neurocritical Care Society guidelines recommend
desmopressin (DDAVP) in patients with antiplatelet-associated ICH with evidence limited
by small cohorts.
Materials and methods
Patients were included in our multi-center, retrospective study if they had computed
tomographic (CT) scan confirmed ICH and were taking antiplatelet medications. Patients
were excluded if hospital length of stay was <24 h, administered DDAVP dose was <0.3
μg/kg, no follow-up head CT scan was performed within the first 24 h after baseline,
major neurosurgical intervention was performed in between CT scans, or the injury
was an acute on chronic ICH. The primary outcome was incidence of hematoma expansion
(defined as >20 % increase from baseline). Secondary outcomes were incidence of thrombotic
complications within 7 days, largest absolute decrease in serum sodium within the
first 24 h, and patient disposition.
Results
Among the 209 patients included in the study, 118 patients received DDAVP while 91
did not. The frequency of hematoma expansion was similar between patients who received
DDAVP and those who did not (16.1 % vs 17.6 %; P = 0.78). No difference in secondary outcomes was observed between the two groups.
Conclusions
These findings in conjunction with recently published literature may suggest minimal
benefit or harm with DDAVP treatment. However, further study could elucidate any potential
impact on long-term function outcomes.
Keywords
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Article info
Publication history
Published online: December 27, 2022
Accepted:
December 22,
2022
Received in revised form:
December 14,
2022
Received:
May 20,
2022
Identification
Copyright
Published by Elsevier Ltd.
