Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Neurocrit Care. 2021 Jun;34(3):1026-1046. doi: 10.1007/s12028-020-01055-6. Epub 2020 Aug 4.
An increasing number of patients receive antiplatelet therapy. Patients exposed to surgery while receiving platelet inhibitors hold an increased bleeding risk. Especially in neurosurgery and neurocritical care patients, bleeding and hematoma expansion are feared complications as even minor bleedings may be hazardous. The objective of this systematic review was to investigate the effect of desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP) on platelet function during antiplatelet therapy in patients undergoing non-cardiac surgery, patients who experience spontaneous or traumatic hemorrhage, healthy individuals and in animals.
Studies were identified through a systematic literature search in PubMed and EMBASE on August 19, 2019, with an update on May 2, 2020, and from reference lists of the included studies. Data on clinical and biochemical effect of DDAVP were extracted from included studies for a qualitative data synthesis.
In total, 22 studies were included: 18 human studies and four animal studies. Overall, DDAVP improved bleeding time and increased platelet aggregation in patients undergoing non-cardiac surgery, patients suffering intracerebral or subarachnoid hemorrhage while receiving antiplatelet therapy as well as in healthy individuals and animals exposed to antiplatelet therapy. Observational data indicate that DDAVP may mitigate hematoma expansion in patients with intracerebral hemorrhage or traumatic brain injury.
The present data hold biochemical evidence that DDAVP improves platelet function during antiplatelet therapy in humans and animals. The need for randomized trials is evident in order to evaluate the potential clinical effect of DDAVP in management of patients with spontaneous or traumatic hemorrhage, or undergoing neurosurgery, while receiving antiplatelet therapy.
越来越多的患者接受抗血小板治疗。在接受血小板抑制剂治疗的同时接受手术的患者出血风险增加。特别是在神经外科和神经重症监护病房的患者中，出血和血肿扩大是令人担忧的并发症，即使是轻微的出血也可能是危险的。本系统评价的目的是研究去氨加压素（1-脱氨基-8-D-精氨酸血管加压素，DDAVP）在接受非心脏手术、自发性或外伤性出血、健康个体和动物的接受抗血小板治疗的患者中对血小板功能的影响。
通过系统地在 2019 年 8 月 19 日在 PubMed 和 EMBASE 上进行文献检索，并于 2020 年 5 月 2 日进行更新，从纳入研究的参考文献中确定研究。从纳入的研究中提取有关 DDAVP 的临床和生化效果的数据，以进行定性数据综合。
共纳入 22 项研究：18 项人体研究和 4 项动物研究。总体而言，DDAVP 改善了接受非心脏手术、接受抗血小板治疗的同时发生颅内或蛛网膜下腔出血以及接受抗血小板治疗的健康个体和动物的出血时间和血小板聚集。观察性数据表明，DDAVP 可能减轻颅内出血或外伤性脑损伤患者的血肿扩大。
目前的数据提供了生化证据，表明 DDAVP 可改善人类和动物接受抗血小板治疗期间的血小板功能。需要进行随机试验以评估 DDAVP 在管理自发性或外伤性出血或接受抗血小板治疗的同时接受神经外科手术的患者中的潜在临床效果。
