Ferris State University College of Pharmacy, 25 Michigan Street NE Suite 7000 Grand Rapids, MI 49503, United States.
Spectrum Health Department of Pharmacy, 100 Michigan Street NE Grand Rapids, MI 49503, United States.
J Clin Neurosci. 2019 Aug;66:33-37. doi: 10.1016/j.jocn.2019.05.032. Epub 2019 Jun 1.
Antiplatelet therapy at the time of spontaneous intracerebral hemorrhage (sICH) may increase risk for hemorrhage expansion and mortality. Current guidelines recommend considering a single dose of desmopressin in sICH associated with cyclooxygenase-1 inhibitors or adenosine diphosphate receptor inhibitors. Adult subjects with sICH and concomitant antiplatelet therapy admitted to a large, tertiary care center were included. We sought to compare the risk of hematoma expansion in patients that received desmopressin for antiplatelet reversal in the setting of sICH to similar patients that did not receive desmopressin. The primary outcomes were the incidence of relative and absolute hematoma expansion. In total, 71 patients (29 received desmopressin, 42 did not receive desmopressin) were analyzed. All patients in the desmopressin group received a 0.3 mcg/kg intravenous dose prior to hematoma expansion assessment. Relative hematoma expansion occurred in 5/29 (17%) with desmopressin compared to 11/42 (26%) without desmopressin (OR 0.59 [95% CI 0.18-1.92]). Absolute hematoma expansion occurred in 9/29 (30%) with desmopressin compared to 12/42 (28%) without desmopressin (OR 1.13 [95% CI 0.40-3.16]). Multiple logistic regression controlling for significant covariates did not reveal a significant effect of desmopressin on relative or absolute hematoma expansion (OR 0.65 [95% CI 0.18-2.43] and OR 1.55 [0.48-4.99], respectively). We failed to find evidence that desmopressin administration for antiplatelet reversal in sICH reduces the incidence of hematoma expansion. Larger studies, focusing on the early phase of sICH, are needed to characterize the clinical efficacy and safety of desmopressin for antiplatelet reversal before widespread implementation.
抗血小板治疗自发性脑出血（sICH）可能会增加出血扩大和死亡的风险。目前的指南建议在 sICH 合并环氧化酶-1 抑制剂或腺苷二磷酸受体抑制剂时考虑使用单次剂量的去氨加压素。纳入了在大型三级医疗中心接受治疗的伴有 sICH 和抗血小板治疗的成年患者。我们旨在比较 sICH 患者接受去氨加压素逆转抗血小板治疗与未接受去氨加压素治疗的患者血肿扩大的风险。主要结局是相对和绝对血肿扩大的发生率。共有 71 例患者（29 例接受去氨加压素，42 例未接受去氨加压素）接受了分析。所有接受去氨加压素治疗的患者在血肿扩大评估前均接受了 0.3 mcg/kg 的静脉剂量。与未接受去氨加压素治疗的患者相比，接受去氨加压素治疗的患者中有 5/29（17%）出现相对血肿扩大，11/42（26%）（比值比 0.59 [95%CI 0.18-1.92]）。与未接受去氨加压素治疗的患者相比，接受去氨加压素治疗的患者中有 9/29（30%）出现绝对血肿扩大，12/42（28%）（比值比 1.13 [95%CI 0.40-3.16]）。多变量逻辑回归控制了显著的协变量后，未发现去氨加压素对相对或绝对血肿扩大有显著影响（比值比 0.65 [95%CI 0.18-2.43] 和比值比 1.55 [0.48-4.99]）。我们未能发现去氨加压素用于 sICH 中抗血小板逆转可降低血肿扩大发生率的证据。需要更大规模的研究，重点关注 sICH 的早期阶段，以确定去氨加压素用于抗血小板逆转的临床疗效和安全性，然后再广泛实施。
