Use of Desmopressin in Spontaneous Nontraumatic Intracerebral Hemorrhage Among Patients Taking Antiplatelet Therapy: Systematic Review and Bayesian Meta-analysis.

Abstract

Antiplatelet therapy-associated intracerebral hemorrhage (APT-ICH) remains a significant neurological concern due to high morbidity and mortality among these patients. Early trials of desmopressin (DDAVP) suggested clinical benefit; however, the number of studies available at the time was limited. This systematic review and Bayesian meta-analysis aim to answer whether administration of DDAVP among patients with APT-ICH improves clinical course. Five databases were searched for studies comparing DDAVP and placebo/control/usual care in patients with APT-ICH. Bayesian meta-analysis was performed using a random-effects model with three different priors. A total of seven studies were included. There was no difference in overall mortality [odds ratio (OR) 1.23; 95% credible interval (CrI) 0.79-1.91], in-hospital mortality (OR 1.41; 95% CrI 0.88-2.26), or good functional outcome (OR 0.66; 95% CrI 0.34-1.31). Posterior distribution analysis suggested a possible increase in thromboembolic complications and the proportion of patients with poor neurological outcomes among patients on DDAVP. There is currently a lack of convincing evidence of benefit regarding the administration of DDAVP for patients with APT-ICH. Furthermore, there are several signals that raise concerns for harm.This review indicates that there is no clear, well-supported recommendation to administer DDAVP to patients with APT-ICH.The results of Bayesian meta-analysis reveal a concerning signal for harm with DDAVP administration.