Cohort analysis of desmopressin effect on hematoma expansion in patients with spontaneous intracerebral hemorrhage and documented pre-ictus antiplatelet use

Schmidt, Kyle J.; Sager, Brooke; Zachariah, Joseph; Raad, Bassel; James, Elysia; Fletcher, Jeffrey J.

doi:10.1016/j.jocn.2019.05.032

Cited by 15 publications

(10 citation statements)

References 25 publications

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“…Despite differences in patient characteristics and etiology of ICH in this study compared to previous studies, the rates of hematoma expansion were similar (30%-43.7%). 12,14 Similar to previous studies, there was no difference in hematoma expansion, hyponatremia, or thrombotic complications between groups. 12,15,17 However, hyponatremia and hypertonic saline administration were numerically higher in the DDAVP group, although these findings did not reach statistical significance.…”

Section: Discussionsupporting

confidence: 85%

“…10 Published outcomes data have assessed both doses of DDAVP and the data does not support 1 dosing regimen over another. 9,13,14 Additionally, adverse effects, including hyponatremia and thrombotic events, were similar in this study compared to previous studies. 12 -16 One of the primary factors that may have influenced the use of DDAVP in patients with alcohol use was their BAL on admission as the DDAVP group had a higher median BAL (DDAVP 207 mg/dL vs non-DDAVP 47.5 mg/dL, P = 0.106).…”

Section: Discussionsupporting

confidence: 84%

“…9,13,14 Additionally, adverse effects, including hyponatremia and thrombotic events, were similar in this study compared to previous studies. 12 -16 One of the primary factors that may have influenced the use of DDAVP in patients with alcohol use was their BAL on admission as the DDAVP group had a higher median BAL (DDAVP 207 mg/dL vs non-DDAVP 47.5 mg/dL, P = 0.106). Given the higher median BAL, the concern for platelet dysfunction, potentially during neurosurgery, may have contributed to the decision to administer of DDAVP.…”

Section: Discussionsupporting

confidence: 84%

“…Previous studies in antiplatelet-associated ICH have reported variable outcomes in hematoma progression and hyponatremia and no significant increase in thrombotic events with the use of DDAVP. [12][13][14][15][16] The initial study evaluating the effects of DDAVP on hemostasis time demonstrated an improvement from baseline to 1 hour, although this study evaluated patients with known aspirin use or reduced platelet function. Safety outcomes reported a mean change of 0.6 mEq/L in sodium and no reported thrombotic complications.…”

Section: Discussionmentioning

confidence: 99%

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The Safety and Efficacy of Desmopressin in Patients With Intracranial Hemorrhage and a History of Alcohol Use

Gunther

Witenko

Prust

et al. 2021

J Intensive Care Med

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Background: Patients with a history of alcohol use disorder are at an increased risk of hematoma expansion following intracranial hemorrhage (ICH) due to the effects of alcohol on platelet aggregation. Desmopressin (DDAVP) improves platelet aggregation and may decrease hematoma expansion in patients with ICH. However, DDAVP may also increase the risk of hyponatremia and thrombotic events. Evidence is limited regarding the safety and efficacy of DDAVP in alcohol use (AU)-associated ICH. Methods: This was a retrospective chart review of adult patients with radiographic evidence of ICH and a confirmed or suspected history of alcohol use upon admission. Patients were categorized into groups based on DDAVP administration. Safety outcomes included hyponatremia (serum sodium <135 mEq/L or decrease in serum sodium of ≥ 5 mEq/L for patients with baseline sodium <135 mEq/L) within 24 hours of ICH and thrombotic events within 7 days of ICH. The primary efficacy outcome was the incidence of hematoma expansion, defined as any expansion of the hemorrhage noted on repeat imaging within 32 hours. Results: In total, 52 patients were included in the safety analysis (27 DDAVP and 25 non-DDAVP). Although hyponatremia was numerically higher in the DDAVP group, there was no significant difference between groups (19.2% vs 4.2%, P = 0.192). Thrombotic complications were similar between the DDAVP and non-DDAVP groups (11.1% vs. 8%, P = 1.0). Thirty-nine patients met criteria for hemostatic efficacy analysis. There was no difference in hematoma expansion between the DDAVP and non-DDAVP groups (23.1% vs 34.6%, P = 0.71) and these findings were consistent after adjusting for differences in baseline characteristics (OR 0.63, 95% CI 0.1-3.3). Conclusion: The administration of DDAVP was not associated with adverse safety events, but did not significantly reduce the incidence of hematoma expansion in patients with AU-associated ICH.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Safety and Efficacy of Desmopressin in Patients With Intracranial Hemorrhage and a History of Alcohol Use

Gunther

Witenko

Prust

et al. 2021

J Intensive Care Med

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“…While platelet transfusion in the acute setting seems like a plausible therapy, a recent trial failed to show a positive clinical effect and even suggested that platelet transfusion was, in fact, deleterious in these patients (13). More recent studies focusing on desmopressin, an agent thought to activate platelets, also didn't shown a positive effect on recovery (21,22).…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome in Patients With Intracerebral Hemorrhage Stratified by Type of Antithrombotic Therapy

et al. 2021

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Background: Antithrombotic therapy influences clinical outcome after spontaneous intracerebral hemorrhage (ICH). However, evidence on the effect of different antithrombotic therapies on outcome and a comparison between different therapies is scarce, while this is important for medical decision making. Therefore, we investigated clinical outcome after ICH stratified by type of antithrombotic therapy.Patients/Methods: We performed a cohort study selecting consecutive ICH patients from our database, excluding patients without data on medication or therapeutic heparin use. Primary outcome was poor outcome (modified Rankin Scale ≥ 4) after 90 days. Secondary outcome was mortality at 90 days. We analyzed outcome and survival in patients with ICH using vitamin K antagonists (VKA), antiplatelet therapy (AP), and direct oral anticoagulant (DOAC) compared to no antithrombotic therapy adjusted for age, National Institutes of Health Stroke Scale (NIHSS), infratentorial localization, intraventricular extension, history of hypertension, diabetes, or stroke, and interaction between age and NIHSS.Results: We included 916 patients (223 AP, 161 VKA, and 40 DOAC). VKA (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI], 1.6–6.3) and AP (aOR = 2.0, 95%CI: 1.1–3.7) were associated with poor outcome. DOAC use did not reach statistical significance (aOR = 2.4, 95%CI: 0.8–7.7). Patients who used any antithrombotic therapy had poorer survival compared to patients without antithrombotic treatment and patients using AP and DOAC had better survival compared to VKA after adjustment.Conclusions: Patients with antithrombotic therapy have worse clinical outcome after ICH. Patients using VKA have higher risk of poor outcome and mortality compared to patients using AP. These findings highlight the deleterious effect of antithrombotic therapy in patients with ICH and stress the need for effective therapies for ICH patients.

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Safety and efficacy of desmopressin (DDAVP) in preventing hematoma expansion in intracranial hemorrhage associated with antiplatelet drugs use: A systematic review and metaanalysis

Shahzad,

Ahmed,

Muhammad

et al. 2024

Brain and Behavior

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IntroductionOne of the most serious complications associated with antiplatelet agents is antiplatelet‐associated intracranial hemorrhage (AA‐ICH). Desmopressin is a synthetic antidiuretic hormone (ADH) analog. It has been linked to improving patient outcomes in antiplatelet‐induced intracranial hemorrhage. The secondary outcomes included the incidence of thrombotic complications and neurological outcomes.MethodsA systematic search was conducted on three databases (PubMed, Cochrane, and ClinicalTrials.gov) to find eligible literature that compares desmopressin (DDAVP) versus controls in patients with AA‐ICH. The Mantel–Haenszel statistic was used to determine an overall effect estimate for each outcome by calculating the risk ratios and 95% confidence intervals (CI). Heterogeneity was measured using the I2 test. The risk of bias in studies was calculated using the New Castle Ottowa Scale.ResultsFive studies were included in the analysis with a total of 598 patients. DDAVP was associated with a nonsignificant decrease in the risk of hematoma expansion (RR = .8, 95% CI,.51–1.24; p = .31, I2 = 44%). It was also associated with a non‐significant decrease in the risk of thrombotic events (RR,.83; 95% CI,.25–2.76; p = .76, I2 = 30%). However, patients in the DDAVP group demonstrated a significant increase in the risk of poor neurological outcomes (RR, 1.31; 95% CI, 1.07–1.61; p = .01, I2 = 0%). The risk of bias assessment showed a moderate to low level of risk.ConclusionDDAVP was associated with a nonsignificant decrease in hematoma expansion and thrombotic events. However, it was also associated with a significantly poor neurological outcome in the patients. Thus, until more robust clinical trials are conducted, the use of DDAVP should be considered on a case‐to‐case basis.

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Cohort analysis of desmopressin effect on hematoma expansion in patients with spontaneous intracerebral hemorrhage and documented pre-ictus antiplatelet use

Cited by 15 publications

References 25 publications

The Safety and Efficacy of Desmopressin in Patients With Intracranial Hemorrhage and a History of Alcohol Use

The Safety and Efficacy of Desmopressin in Patients With Intracranial Hemorrhage and a History of Alcohol Use

Clinical Outcome in Patients With Intracerebral Hemorrhage Stratified by Type of Antithrombotic Therapy

Safety and efficacy of desmopressin (DDAVP) in preventing hematoma expansion in intracranial hemorrhage associated with antiplatelet drugs use: A systematic review and metaanalysis

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