Impact of Desmopressin on Clinical Outcomes in Patients with Spontaneous Antiplatelet-Associated Intracerebral Hemorrhage Undergoing Neurosurgical Intervention: An Observational Multi-Center Study.
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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) 4 - 6 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. There were no significant differences in mRS of 4 - 6 at discharge between groups (84.3% vs 88.2%; p = 0.692). 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 no significant difference in mRS at discharge or SAEs between patients with and without DDAVP administration. However, this null finding should be interpreted cautiously due to the study being underpowered. Further randomized controlled trials are warranted to validate our findings.
期刊介绍：
SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.
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