(690) Efficacy and Safety of Desmopressin in Antiplatelet-Associated Intracranial Hemorrhage

Introduction: Available evidence for antiplatelet-associated intracranial hemorrhage (ICH) is mixed, but there has been an association with increased risk of hematoma expansion, increased mortality, and worse functional outcomes. The benefit of desmopressin (DDAVP) in reducing hematoma expansion in antiplatelet-associated ICH is controversial based on available literature. The purpose of this study is to evaluate the efficacy and safety of DDAVP in any type of antiplatelet-associated ICH with an emphasis on platelet function assay data.

Methods: This was a single center, retrospective descriptive study evaluating the safety and efficacy of DDAVP for the treatment and management of anti-platelet associated ICH. This study was conducted at a 914-bed Level I trauma center from June 1, 2021, to June 30, 2023. The primary objective of this study was to compare the incidence of hematoma expansion, defined as a greater than 20% increase in size or a new hematoma not present on initial computed tomography (CT) scan. Patients were included in this study if they were 18 years of age or older, had documented anti-platelet medication(s) on home medication list or in the provider note, had intracranial hemorrhage, spontaneous or traumatic, confirmed on CT imaging, and had elevated PFA (Col/Epi) data documented.

Results: 90 patients were screened for inclusion during the study period, with 28 patients meeting inclusion criteria. All 28 patients included in this study received IV DDAVP dosed anywhere from 0.3mcg/kg to 0.4mcg/kg, with doses rounded to the nearest tenth as needed. The median age of the study population was 76.5 years [64.5-83.75], and 64.2% were male. Every patient included in this study had clinically elevated PFAs. Most commonly, patients presented with a traumatic ICH (85.7%), with the predominating type being subdural hematoma (78.6%). Hematoma expansion occurred in 14.3% of patients included in this study. There were no thrombotic events reported within 7 days of receiving DDAVP. The median decrease in serum sodium after DDAVP administration was 1 mEq/L. The median length of hospital stay was 3.5 days [1.255-11].

Conclusions: In patients with antiplatelet-associated ICH, the administration of DDAVP was found to be safe and effective in preventing hematoma expansion.