Department of Neurology & Stroke, University Hospital Tübingen, Tübingen, Germany.
Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Crit Care Med. 2020 Jul;48(7):1009-1017. doi: 10.1097/CCM.0000000000004348.
To investigate the hemostatic efficacy of combined desmopressin (1-deamino-8-D-arginine vasopressin) and platelet transfusion in reducing hematoma expansion in acute, spontaneous intracerebral hemorrhage under antiplatelet treatment.
Single-center, nonrandomized study, performed between 2006 and 2014.
Tertiary University Hospital of Tuebingen, Germany.
Adult patients with intracerebral hemorrhage under antiplatelet treatment and follow-up CT at 24 ± 12 hours were included. Exclusion criteria included other intracerebral hemorrhage causes, anticoagulation, coagulopathy, or immediate surgery after baseline-CT.
Treatment with IV 1-deamino-8-D-arginine vasopressin (0.4 µg/kg) + platelet transfusion (2 U) within 60 minutes of intracerebral hemorrhage under antiplatelet treatment diagnosis on brain imaging.
Primary outcome was relative hematoma expansion from baseline to follow-up CT. Secondary outcomes included secondary intraventricular hemorrhage or hydrocephalus upon follow-up CT, thromboembolic events before discharge, and the 3-month functional outcome (assessed by modified Rankin Scale). One-hundred forty patients were included, 72 treated versus 68 controls. Times of symptom-onset-to-baseline-CT (hr) (median [interquartile range]: 3 [4] vs 5 [5]; p = 0.468) and follow-up CT (26 [18] vs 19 [12]; p = 0.352) were similar between groups. No between-group differences of total intracerebral hematoma expansion (%) (median [interquartile range]: 8.5 [12.4] vs 9.1 [16.5]; p = 0.825), intraparenchymal (10.7 [23.1] vs 9.2 [20.7]; p = 0.900), and intraventricular hematoma expansion (14.5 [63.2] vs 6.1 [40.4]; p = 0.304) were noted. Among patients with hematoma expansion greater than or equal to 33% compared with baseline, 16 (52%) received treatment versus 15 (48%) controls. The occurrence of hematoma expansion greater than or equal to 33% was similar between groups (p = 0.981). Rates of secondary intraventricular hemorrhage, hydrocephalus, and thromboembolic events were similar between groups. Treatment with 1-deamino-8-D-arginine vasopressin + platelet transfusion was not associated with the 3-month functional outcome (adjusted odds ratio, 1.570; 95% CI, 0.721-3.419; p = 0.309).
In line with the randomized Platelet Transfusion Versus Standard Care After Acute Stroke Due to Spontaneous Cerebral Hemorrhage Associated With Antiplatelet Therapy trial, our results suggest no hemostatic efficacy of early platelet transfusion in intracerebral hemorrhage under antiplatelet treatment. Contrary to results of preclinical and clinical nonintracerebral hemorrhage studies, adjunct 1-deamino-8-D-arginine vasopressin showed no benefit in limiting hematoma expansion or improving functional outcome.
研究联合使用去氨加压素（1-脱氨基-8-D-精氨酸血管加压素）和血小板输注在减少抗血小板治疗下急性自发性脑出血血肿扩大方面的止血效果。
单中心、非随机研究，于 2006 年至 2014 年进行。
德国图宾根大学附属医院。
包括接受抗血小板治疗和 24±12 小时随访 CT 的颅内出血的成年患者。排除标准包括其他颅内出血原因、抗凝、凝血障碍或基线 CT 后立即手术。
在脑成像诊断抗血小板治疗下颅内出血后 60 分钟内给予 IV 去氨加压素（0.4μg/kg）+血小板输注（2U）。
主要结局是从基线到随访 CT 的相对血肿扩大。次要结局包括随访 CT 时出现继发性脑室内出血或脑积水、出院前血栓栓塞事件以及 3 个月的功能结局（采用改良 Rankin 量表评估）。共纳入 140 例患者，72 例接受治疗，68 例为对照组。两组的症状发作至基线 CT 时间（小时）（中位数[四分位距]：3[4]比 5[5]；p=0.468）和随访 CT 时间（26[18]比 19[12]；p=0.352）相似。两组总颅内血肿扩大百分比（中位数[四分位距]：8.5[12.4]比 9.1[16.5]；p=0.825）、脑实质内（10.7[23.1]比 9.2[20.7]；p=0.900）和脑室内血肿扩大（14.5[63.2]比 6.1[40.4]；p=0.304）无差异。与基线相比，血肿扩大大于等于 33%的患者中，16 例（52%）接受治疗，15 例（48%）对照组接受治疗。两组血肿扩大大于等于 33%的发生率相似（p=0.981）。继发性脑室内出血、脑积水和血栓栓塞事件的发生率在两组间相似。去氨加压素+血小板输注治疗与 3 个月的功能结局无关（调整后的优势比，1.570；95%置信区间，0.721-3.419；p=0.309）。
与随机血小板输注与标准治疗急性卒中后颅内出血的血小板治疗试验一致，我们的结果表明，抗血小板治疗下颅内出血早期血小板输注没有止血作用。与非颅内出血的临床前和临床研究结果相反，辅助使用去氨加压素在限制血肿扩大或改善功能结局方面没有益处。
