The use of desmopressin acetate in patients presenting with intracranial hemorrhage: A review

Objective This review presents current literature on desmopressin acetate as mono- and adjuvant therapy and its ability to stabilize platelet function in patients presenting with intracranial hemorrhage on pre-injury antiplatelet agents of aspirin, clopidogrel, prasugrel and/or ticagrelor. Design PubMed, MEDLINE and International Pharmaceutical Abstracts were searched through to 1st March 2016. Inclusion criteria were case reports, reviews, short communications and brief reports on reported patients with any type of intracranial hemorrhage while on oral antiplatelet agents. Reports on desmopressin acetate in surgical candidates were excluded due to the nature of the bleed. Results A scoping search was performed in three databases with 89 articles identified based on the search criteria. All returned articles were evaluated by the authors with four articles suitable for inclusion. Conclusion While desmopressin acetate has a promising mechanism of action for enhancing primary hemostasis, the articles reported conflicting results possibly due to limited study sample sizes, lack of standards on measuring platelet function, data on weight-based dosing and guidelines. Further research is needed to evaluate desmopressin acetate as monotherapy. If used, it should be considered adjunct therapy to platelet transfusions for patients on oral antiplatelet agents requiring emergent hemostasis.