Desmopressin administration and rebleeding in subarachnoid hemorrhage: analysis of an observational prospective database

Abstract

OBJECTIVE Rebleeding remains a frequent and catastrophic event leading to poor outcome after subarachnoid hemorrhage (SAH). Reduced platelet function after the initial bleed is associated with higher risk of early rebleeding. Desmopressin (DDAVP) is a well-known hemostatic agent, and recent guidelines already suggest its use in individuals exposed to antiplatelet drugs. The authors hypothesized that DDAVP administration in patients with SAH at admission would be associated with lower risks of rebleeding. METHODS The authors performed an observational cohort study of patients enrolled in the Columbia University SAH Outcome Project between August 1996 and July 2015. The authors compared the rate of rebleeding between patients who were and those who were not treated with DDAVP. After adjustment for known predictors, logistic regression was used to measure the association between treatment with DDAVP and risks of rebleeding. RESULTS Among 1639 patients with SAH, 12% were treated with DDAVP. The main indication for treatment was suspected exposure to an antiplatelet agent. The overall incidence of rebleeding was 9% (1% among patients treated with DDAVP compared with 8% among those not treated). After adjustment for antiplatelet use and known predictors, treatment with DDAVP was associated with a 45% reduction in the risks of rebleeding (adjusted OR 0.55, 95% CI 0.27-0.97). DDAVP was associated with a higher incidence of hyponatremia but not with thrombotic events or delayed cerebral ischemia. CONCLUSIONS Treatment with DDAVP was associated with a lower risk of rebleeding among patients with SAH. These findings support further study of DDAVP as first-line therapy for medical hemostasis in patients with SAH.

The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage

“…Al and facile prediction method for prioritizing early treatment, such as early or ultra-early aneurysm repair and the use of antifibrinolytic drugs (103,104). The NLR has been shown to predict the occurrence of rebleeding, which may be explained by the mechanism that neutrophil recruitment changes the stability of the ruptured aneurysm wall (73, 105).…”

Stroke Classification: Critical Role of Unusually Large von Willebrand Factor Multimers and Tissue Factor on Clinical Phenotypes Based on Novel “Two-Path Unifying Theory” of Hemostasis

“…Potential hemostatic agents based on in vivo hemostatic theory includes such as desmopressin and recombinant FVIIa that promote thrombogenesis of in vivo hemostasis. 117 – 119 …”

“…Desmopressin has been used in both primary ICH in the absence of underlying vascular malformation or coagulopathy and secondary ICH due to underlying vascular anomaly or anticoagulation state. 117 , 118 Hematoma expansion is a detrimental outcome of spontaneous ICH, resulting in significant neurological deficits, and enhancement of ICH-induced brain injury. 124 Desmopressin stabilized the platelet function in neurosurgical patients with secondary intracranial hemorrhage, 117 , 125 and was associated with a decreased likelihood of intracranial hemorrhage/hematoma expansion during the first 24 hours in retrospective assessment of its effectiveness and safety in patients with antiplatelet-associated ICH.…”

“…Potential hemostatic agents based on in vivo hemostatic theory includes such as desmopressin and recombinant FVIIa that promote thrombogenesis of in vivo hemostasis. [117][118][119] Desmopressin. Desmopressin, a synthetic analog of vasopressin, in addition to its utility in several conditions such as diabetes insipidus, uremic bleeding, and nocturnal enuresis has been approved for use in the treatment of hemophilia A, von Willebrand disease type 1, and congenital and acquired platelet dysfunction.…”

The Hemostatic Activity of Bis (2-Aminoethan-1-Sulfonate) Calcium

“…It is known that local or systemic injection of hemostatic drugs is used to reduce blood loss and number of blood transfusions in patients with hypocoagulation and hemorrhagic diathesis. Examples include products based on fibrin or thrombin for local hemostasis in abdominal surgery or traumatology [1], proton-pump inhibitors to prevent recurrence of bleeding from the gastrointestinal tract [2], antifibrinolytic funds, and desmopressin for the system hemostasis [3]. However, drugs to stop bleeding, traditionally used in medical practice, are not always effective to lead to the effective reduction of blood loss which is dangerous due to the development of hemorrhagic shock, dilutional coagulopathy, or thrombosis and thromboembolic complications [4].…”