Safety and efficacy of desmopressin (DDAVP) in preventing hematoma expansion in intracranial hemorrhage associated with antiplatelet drugs use: A systematic review and metaanalysis

• Published in: Brain and behavior Vol. 14; no. 5; pp. e3540 - n/a
• Main Authors: Shahzad, Faizan, Ahmed, Usman, Muhammad, Ayesha, Shahzad, Farhan, Naufil, Syed Imam, Sukkari, Mohamad Walid, Kamran, Abdullah Bin, Murtaza, Sara, Khalid, Marwah Bintay, Shabbir, Haroon, Saeed, Sajeel
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-05-2024; John Wiley and Sons Inc; Wiley
• Subjects: Blood platelets; Cohort analysis; Deamino Arginine Vasopressin - administration & dosage; Deamino Arginine Vasopressin - adverse effects; desmopressin; Drugs; Heart attacks; Hematoma; Hematoma - chemically induced; hematoma expansion; Hemorrhage; Hemostatics - administration & dosage; Hemostatics - adverse effects; Humans; intracerebral hemorrhage; Intracranial Hemorrhages - chemically induced; Ischemia; Meta-analysis; neurocritical care; Original; Patients; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Statistical analysis; Systematic review; Thrombosis; intracerebral hemorrhage; desmopressin; hematoma expansion; neurocritical care
• ISSN: 2162-3279; 2162-3279
• DOI: 10.1002/brb3.3540

Introduction
One of the most serious complications associated with antiplatelet agents is antiplatelet‐associated intracranial hemorrhage (AA‐ICH). Desmopressin is a synthetic antidiuretic hormone (ADH) analog. It has been linked to improving patient outcomes in antiplatelet‐induced intracranial hemorrhage. The secondary outcomes included the incidence of thrombotic complications and neurological outcomes.
Methods
A systematic search was conducted on three databases (PubMed, Cochrane, and ClinicalTrials.gov) to find eligible literature that compares desmopressin (DDAVP) versus controls in patients with AA‐ICH. The Mantel–Haenszel statistic was used to determine an overall effect estimate for each outcome by calculating the risk ratios and 95% confidence intervals (CI). Heterogeneity was measured using the I2 test. The risk of bias in studies was calculated using the New Castle Ottowa Scale.
Results
Five studies were included in the analysis with a total of 598 patients. DDAVP was associated with a nonsignificant decrease in the risk of hematoma expansion (RR = .8, 95% CI,.51–1.24; p = .31, I2 = 44%). It was also associated with a non‐significant decrease in the risk of thrombotic events (RR,.83; 95% CI,.25–2.76; p = .76, I2 = 30%). However, patients in the DDAVP group demonstrated a significant increase in the risk of poor neurological outcomes (RR, 1.31; 95% CI, 1.07–1.61; p = .01, I2 = 0%). The risk of bias assessment showed a moderate to low level of risk.
Conclusion
DDAVP was associated with a nonsignificant decrease in hematoma expansion and thrombotic events. However, it was also associated with a significantly poor neurological outcome in the patients. Thus, until more robust clinical trials are conducted, the use of DDAVP should be considered on a case‐to‐case basis.