Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
J Clin Neurosci. 2021 Apr;86:116-121. doi: 10.1016/j.jocn.2021.01.017. Epub 2021 Feb 3.
The purpose of this study was to perform a systematic review and meta-analysis on the effect of desmopressin on hematoma expansion (HE) in antiplatelet-associated intracerebral hemorrhage (AA-ICH). Secondary outcomes examined were the rate of thrombotic complications and neurologic outcome. Three databases were searched (Pubmed, Scopus, and Cochrane) for randomized clinical trials and controlled studies comparing desmopressin versus controls in adult patients with AA-ICH. The Mantel-Haenszel method was applied to calculate an overall effect estimate for each outcome by combining stratum-specific risk ratio (RR). Risk of bias was computed using the Newcastle-Ottawa Scale. The protocol was registered in PROSPERO (42020190234). Three retrospective controlled studies involving 263 patients were included in the meta-analysis. Compared to controls, desmopressin was associated with a non-significant reduction in HE (19.1% vs. 30%; RR:0.61; 95%CI, 0.27-1.39; P = 0.24), a similar rate of thrombotic events (5.5% vs. 9.9%; RR:0.47; 95%CI, 0.17-1.31; P = 0.15), and significantly worse neurologic outcome (mRS ≥ 4) (66.3% vs. 50%; RR:1.36; 95%CI, 1.08-1.7; P = 0.008). Qualitative analysis of included studies for each outcome revealed low to moderate risk of bias. The available literature does not support the routine use of desmopressin in the setting of AA-ICH. Until larger prospective trials are performed, the administration of desmopressin should be judiciously considered on a case-by-case basis.
本研究旨在对去氨加压素（desmopressin）治疗抗血小板相关脑出血（antiplatelet-associated intracerebral hemorrhage，AA-ICH）患者血肿扩大（hematoma expansion，HE）的效果进行系统评价和荟萃分析。次要结局指标为血栓并发症发生率和神经功能结局。检索了 Pubmed、Scopus 和 Cochrane 三个数据库，纳入了比较去氨加压素与对照组治疗 AA-ICH 成年患者的随机临床试验和对照研究。采用 Mantel-Haenszel 法，按分层特异性风险比（RR）合并各结局的汇总效应估计值。采用 Newcastle-Ottawa 量表计算偏倚风险。方案已在 PROSPERO（42020190234）中注册。纳入的荟萃分析共包含 3 项回顾性对照研究，涉及 263 例患者。与对照组相比，去氨加压素治疗与 HE 无显著降低相关（19.1% vs. 30%；RR：0.61；95%CI：0.27-1.39；P=0.24），血栓事件发生率相似（5.5% vs. 9.9%；RR：0.47；95%CI：0.17-1.31；P=0.15），神经功能结局显著更差（mRS≥4）（66.3% vs. 50%；RR：1.36；95%CI：1.08-1.7；P=0.008）。对各结局纳入研究的定性分析显示，偏倚风险为低至中度。现有文献不支持常规使用去氨加压素治疗 AA-ICH。在进行更大规模的前瞻性试验之前，应谨慎考虑个案应用去氨加压素。
