Desmopressin Improves Platelet Activity in Acute Intracerebral Hemorrhage

Abstract

Background and Purpose— Minimizing hematoma growth in high-risk patients is an attractive strategy to improve outcomes after intracerebral hemorrhage. We tested the hypothesis that desmopressin (DDAVP), which improves hemostasis through the release of von Willebrand factor, improves platelet activity after intracerebral hemorrhage. Methods— Patients with reduced platelet activity on point-of-care testing alone (5), known aspirin use alone (1), or both (8) received desmopressin 0.4 μg/kg IV. We measured Platelet Function Analyzer-epinephrine (Siemens AG, Germany) and von Willebrand factor antigen from baseline to 1 hour after infusion start and hematoma volume from the diagnostic to a follow-up computed tomographic scan. Results— We enrolled 14 patients with of mean age 66.8±14.6 years, 11 (85%) of whom were white and 8 (57%) were men. Mean Platelet Function Analyzer-epinephrine results shortened from 192±18 seconds pretreatment to 124±15 seconds (P=0.01) 1 hour later, indicating improved plate activity. von Willebrand factor antigen increased from 242±96% to 289±103% activity (P=0.004), indicating the expected increase in von Willebrand factor. Of 7 (50%) patients who received desmopressin within 12 hours of intracerebral hemorrhage symptom onset, changes in hematoma volume were modest, −0.5 (−1.4 to 8.4) mL and only 2 had hematoma growth. One patient had low blood pressure and another had a new fever within 6 hours of desmopressin administration. Conclusions— Intravenous desmopressin was well tolerated and improved platelet activity after acute intracerebral hemorrhage. Larger studies are needed to determine its potential effects on reducing hematoma growth versus platelet transfusion or placebo.

Intracerebral Hemorrhage: Perihemorrhagic Edema and Secondary Hematoma Expansion: From Bench Work to Ongoing Controversies

“…However, in humans, prior antiplatelet agent use has been associated with higher risk of HE and poor outcome, with aspirin having the lowest risk as compared to clopidogrel or ticlopidine (135, 150). In a pilot study of 14 ICH patients, desmopressin use was found to be safe and resulted in improvement of platelet function warranting larger studies to confirm these findings (151). A recently completed European randomized, open-label, and phase-III trial studying platelet transfusion versus standard care after acute ICH with prior antiplatelet therapy (PATCH) found two times higher odds of death or dependence at 3 months in patients receiving platelet transfusion (152).…”

High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury

“…A protective effect of hemostatic measures in TBI, pICH and pSAH has been discussed ambiguously. A number of studies have shown a protective effect of hemostatic measures following acute brain injury [6,16,18]. To date, clinical data concerning the efficacy of platelet transfusions for restoring platelet function are limited.…”

Secondary Hematoma Expansion and Perihemorrhagic Edema after Intracerebral Hemorrhage: From Bench Work to Practical Aspects

“…Additional studies related to hemostasis involve the use of platelet transfusions and prothrombin complex concentrate (PCCs) for coagulopathic or antiplatelet-exposed ICH patients and optimization of coagulation before neurosurgical interventions (73–76). One study recently assessed the effect of platelet transfusion in an open-label inception cohort of ICH patients who underwent platelet function assays with Accumetrics (75).…”