{"title":"去氨加压素对接受神经外科干预的自发性抗血小板相关脑出血患者临床结局的影响：一项多中心观察性研究","authors":"Hsu Pang-Ting, Shuo-Chi Chien, Ching-Chang Chen, Zhuo-Hao Liu, Chi-Cheng Chuang, Yu-Chen Tsai, Chung-Hsien Chaou, Chieh-Ching Yen","doi":"10.1097/SHK.0000000000002694","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Desmopressin on Clinical Outcomes in Patients with Spontaneous Antiplatelet-Associated Intracerebral Hemorrhage Undergoing Neurosurgical Intervention: An Observational Multi-Center Study.\",\"authors\":\"Hsu Pang-Ting, Shuo-Chi Chien, Ching-Chang Chen, Zhuo-Hao Liu, Chi-Cheng Chuang, Yu-Chen Tsai, Chung-Hsien Chaou, Chieh-Ching Yen\",\"doi\":\"10.1097/SHK.0000000000002694\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":21667,\"journal\":{\"name\":\"SHOCK\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"SHOCK\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SHK.0000000000002694\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"SHOCK","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SHK.0000000000002694","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的：治疗急性自发性脑出血（ICH）患者的外科病例，由于出血风险增加，抗血小板治疗提出了重大挑战。去氨加压素醋酸酯（DDAVP）通常被用作治疗策略。这项多中心研究旨在比较自发性抗血小板相关性脑出血后术前给予或未给予DDAVP的患者的功能和安全性结果。方法：2016年1月至2023年11月，我们招募了在急诊科接受抗血小板治疗并需要神经外科干预的自发性脑出血患者。排除外伤性脑损伤、脑出血、蛛网膜下腔出血、动静脉畸形、颅内肿瘤、凝血功能障碍和抗凝剂使用的患者。主要预后指标为出院时的改良Rankin量表（mRS） 4 - 6。次要终点包括安全性结局、住院结局和随访结局。结果：共纳入75例患者，其中DDAVP组26例，对照组49例。治疗加权调整逆概率后，基线特征无显著差异。4 ~ 6级患者出院时mRS差异无统计学意义（84.3% vs 88.2%; p = 0.692）。多变量广义估计方程logistic回归表明，DDAVP与改善的功能结局、安全结局、住院结局或随访结局无显著相关。结论：本研究显示，使用和未使用DDAVP的患者在出院时mRS或SAEs方面无显著差异。然而，由于这项研究的效力不足，应该谨慎地解释这一无效发现。需要进一步的随机对照试验来验证我们的发现。
Impact of Desmopressin on Clinical Outcomes in Patients with Spontaneous Antiplatelet-Associated Intracerebral Hemorrhage Undergoing Neurosurgical Intervention: An Observational Multi-Center Study.
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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