In this episode, I’ll discuss an article about desmopressin effectiveness and safety in patients with antiplatelet-associated intracranial hemorrhage.
Retrospective Assessment of Desmopressin Effectiveness and Safety in Patients With Antiplatelet-Associated Intracranial Hemorrhage
Lead author: Elizabeth Feldman
Published ahead of print in Critical Care Medicine
Back in episode 51 I reviewed the Guidelines for Reversal of Antithrombotics in Intracranial Hemorrhage by the Neurocritical Care Society and Society of Critical Care Medicine. These guidelines include a conditional recommendation to give DDAVP 0.4mcg/kg for intracranial hemorrhage associated with aspirin/COX-1 inhibitors or ADP receptor inhibitors.
The recommendation was based on weak and limited evidence, and the authors of this study sought to add to the literature available by performing the first comparative assessment analyzing DDAVP effectiveness and safety in antiplatelet-associated intracranial hemorrhage.
This analysis was a retrospective chart review at a single center. Adult patients with evidence of ICH on CT scan who were taking at least one antiplatelet agent were included. A total of 124 patients were analyzed; 55 received DDAVP and 69 did not.
The primary effectiveness outcome was intracranial hemorrhage expansion greater than or equal to 3 mL during the first 24 hospital hours.
The primary safety outcomes were the largest absolute decrease from baseline serum sodium during the first 3 treatment days and new-onset thrombotic events during the first 7 days.
Receipt of DDAVP was associated with an 88% decreased likelihood of intracranial hemorrhage expansion during the first 24 hours compared to the group of patients who did not receive DDAVP.
The safety outcomes did not differ between groups.
The authors concluded:
DDAVP was associated with a decreased likelihood of intracranial hemorrhage expansion during the first 24 hours. DDAVP administration did not significantly affect serum sodium and thrombotic events during the study period.
This study is small and retrospective, however, it is the first to show a benefit of DDAVP administration compared to no DDAVP. While the primary outcome of effectiveness was a surrogate endpoint of hematoma volume expansion, this endpoint is well-correlated with improved functional outcomes.
As there is no alternative to DDAVP, this study does add to the strength of available data suggesting it should be considered in ICH in patients on an anti-platelet agent. It should be noted that most of the patients in this study were on aspirin only or aspirin plus clopidogrel rather than the newer antiplatelet agents.
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