Key result
Desmopressin was associated with a nonsignificant decrease in hematoma expansion (RR 0.8; 95% CI 0.51-1.24; p=0.31) but significantly increased the risk of poor neurological outcomes.
Why the study?
Antiplatelet-associated intracranial hemorrhage is a serious complication, and desmopressin has been linked to improving patient outcomes.
Does desmopressin reduce hematoma expansion in patients with antiplatelet-associated intracranial hemorrhage?
Meta-Analysis (n=598)
Does desmopressin reduce hematoma expansion in patients with antiplatelet-associated intracranial hemorrhage?
In patients with antiplatelet-associated intracranial hemorrhage, desmopressin does not significantly reduce hematoma expansion and is associated with worse neurological outcomes.
Desmopressin shows no benefit on hematoma expansion and may increase poor neurological outcomes in AA-ICH; leaves open its role pending RCTs.
Introduction One 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. Methods A 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 I 2 test. The risk of bias in studies was calculated using the New Castle Ottowa Scale. Results Five 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, I 2 = 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, I 2 = 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, I 2 = 0%). The risk of bias assessment showed a moderate to low level of risk. Conclusion DDAVP 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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Shahzad et al. (2024) conducted a meta-analysis in Antiplatelet-associated intracranial hemorrhage (AA-ICH) (n=598). Desmopressin (DDAVP) vs. Controls was evaluated on Hematoma expansion (RR 0.8, 95% CI 0.51-1.24, p=0.31). Desmopressin was associated with a nonsignificant decrease in hematoma expansion (RR 0.8; 95% CI 0.51-1.24; p=0.31) but significantly increased the risk of poor neurological outcomes.
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