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Abstract Objective: Managing surgical cases of acute spontaneous intracerebral hemorrhage (ICH) in patients with antiplatelet therapy presents significant challenges due to the heightened risk of bleeding. Desmopressin acetate (DDAVP) is commonly employed as a management strategy. This multi-center study aims to compare the functional and safety outcomes in patients with or without preoperative DDAVP administration after spontaneous antiplatelet-associated ICH. Methods: From January 2016 to November 2023, we enrolled patients with spontaneous ICH who were under antiplatelet therapy and needed neurosurgical interventions in the emergency departments. Patients were excluded for traumatic brain injury, ICH from subarachnoid hemorrhage, arteriovenous malformation, intracranial tumors, coagulopathies, and anticoagulant use. The primary outcome was the modified Rankin Scale (mRS) at discharge. Secondary endpoints included safety outcomes, in-hospital and follow-up outcomes. Results: A total of 75 patients were included, comprising 26 patients treated with DDAVP and 49 patients in the control group. After inverse probability of treatment weighting adjustment, there were no significant differences in baseline characteristics except for preoperative platelet transfusion between the DDAVP and control group (73.6% vs 33.6%; p = 0.007). There were no significant differences in mRS of 4 – 6 at discharge between groups (77.4% vs 85.1%; p = 0.533). Multivariable generalized estimating equations logistic regression demonstrated DDAVP was not significantly associated with improved functional outcome, safety outcomes, in-hospital or follow-up outcomes. Conclusion: This study demonstrated that there was no significant difference in mRS at discharge or SAEs between patients with and without DDAVP administration. Further randomized controlled trials are warranted to validate our findings.
Hsu et al. (Wed,) studied this question.