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Retrospective Assessment of Desmopressin Effectiveness and Safety in Patients With Antiplatelet-Associated Intracranial Hemorrhage*

Feldman, Elizabeth A. PharmD, BCPS, BCGP1; Meola, Gregory PharmD, BCCCP1; Zyck, Stephanie MD2; Miller, Christopher D. PharmD, BCPS1; Krishnamurthy, Satish MD2; Cwikla, Gregory M. PharmD, BCCCP1; Darko, William BPharm, PharmD, BCCCP1; Jennings, Shane MD, MA3; Sullivan, Ross MD4; Seabury, Robert PharmD, BCPS, DABAT1

doi: 10.1097/CCM.0000000000004021
Neurologic Critical Care
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Objective: Current international guidelines offer a conditional recommendation to consider a single dose of IV desmopressin (DDAVP) for antiplatelet-associated intracranial hemorrhage based on low-quality evidence. We provide the first comparative assessment analyzing DDAVP effectiveness and safety in antiplatelet-associated intracranial hemorrhage.

Design: Retrospective chart review.

Setting: Single tertiary care academic medical center.

Patients: Adult patients taking at least one antiplatelet agent based on presenting history and documented evidence of intracranial hemorrhage on cerebral CT scan were included. Patients were excluded for the following reasons: repeat cerebral CT scan not performed within the first 24 hours, noncomparative repeat cerebral CT scan, chronic anticoagulation, administration of fibrinolytic medications, concurrent ischemic stroke, and neurosurgical intervention. In total, 124 patients were included, 55 received DDAVP and 69 did not.

Interventions: DDAVP treatment at recognition of antiplatelet-associated intracranial hemorrhage versus nontreatment.

Measurements and Main Results: Primary effectiveness outcome was intracranial hemorrhage expansion greater than or equal to 3 mL during the first 24 hospital hours. 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. DDAVP was associated with 88% decreased likelihood of intracranial hemorrhage expansion during the first 24 hours ([+] DDAVP, 10.9% vs [–] DDAVP, 36.2%; p = 0.002; odds ratio [95% CI], 0.22 [0.08–0.57]). Largest median absolute decrease from baseline serum sodium ([+] DDAVP, 0 mEq/L [0–5 mEq/L] vs [–] DDAVP, 0 mEq/L [0–2 mEq/L]; p = 0.089) and thrombotic events ([+] DDAVP, 7.3% vs [–] DDAVP, 1.4%; p = 0.170; odds ratio [95% CI], 5.33 [0.58–49.16]) were similar between groups.

Conclusions: 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.

1Department of Pharmacy, Upstate University Hospital, Syracuse, NY.

2Department of Neurosurgery, Upstate University Hospital, Syracuse, NY.

3Department of Emergency Medicine, UT Health San Antonio, San Antonio, TX.

4Department of Emergency Medicine, Division of Toxicology, Upstate University Hospital, Syracuse, NY.

*See also p. 1815.

Dr. Krishnamurthy received research grant funding from Reach Foundation CNY and Pediatric Hydrocephalus Foundation (unrelated work on hydrocephalus). The remaining authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at the Upstate University Hospital.

For information regarding this article, E-mail: feldmane@upstate.edu, Address requests for reprints to: Elizabeth A. Feldman, PharmD, BCPS, BCGP, Department of Pharmacy, Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210. E-mail: feldmane@upstate.edu

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