Journal article
Impact of desmopressin on hematoma expansion in patients presenting to the emergency department on antiplatelet therapy: Don't expand study
The American journal of emergency medicine, Vol.93, pp.126-131
07/2025
DOI: 10.1016/j.ajem.2025.03.052
PMID: 40186945
Abstract
Current guidelines state the effectiveness of desmopressin to reduce hematoma expansion in antiplatelet-related intracerebral hemorrhage (ICH) is uncertain. This study sought to determine if desmopressin decreased hematoma expansion in ICH patients on antiplatelet agents.
We conducted a multi-center, retrospective propensity-matched cohort study at 11 US emergency departments (ED) that participate in EMPHARM-NET. Adult patients ≥18 years with a primary diagnosis of spontaneous ICH on antiplatelets prior to admission from January 1, 2017 through May 1, 2021 were included. The primary endpoint was good or excellent hemostatic efficacy within the first 24 h following ICH between patients that did and did not receive desmopressin. Brain imaging was reviewed using 3D-Slicer by blinded expert physicians.
Overall, 1408 patients were evaluated for inclusion. A total of 324 patients were included, of which 13.8 % (n = 45) received desmopressin and 86.1 % (n = 279) did not. After propensity matching, 35 patients receive desmopressin compared to 140 controls. Baseline hematoma volume (27.6 mL vs. 2.1 mL) and was significantly higher in the desmopressin group. The primary endpoint of good or excellent hemostatic efficacy was similar between groups (74.3 % desmopressin group vs. 85 % control group, −10.7 % [−28.1 % to 6.7 %]). There was no difference in secondary outcomes.
In this multicenter cohort, patients receiving desmopressin had higher baseline intraparenchymal hematoma volume, and did not appear to result in improved hemostatic efficacy relative to the control group. These results suggest against routine administration of desmopressin for antiplatelet-related ICH, though future study in a randomized trial design is necessary.
Details
- Title: Subtitle
- Impact of desmopressin on hematoma expansion in patients presenting to the emergency department on antiplatelet therapy: Don't expand study
- Creators
- Megan A. Rech - Edward Hines, Jr. VA HospitalCaitlin Brown - Mayo ClinicGiles W. Slocum - Rush University Medical CenterBrian W. Gilbert - Wesley Medical CenterDeep Aggarwal - Loyola University Medical CenterGavin T. Howington - University of Kentucky HealthCareTara Flack - Methodist HospitalAtul Malik - Loyola University Medical CenterBrett A. Faine - University of Iowa College of Pharmacy and College of Medicine, University of Iowa, Iowa City, IA, United States of AmericaMichael Ayad - University of Rochester Medical CenterSamantha Delibert - University of Rochester Medical CenterBenjamin P. George - Loyola University Medical CenterLuis Guerrero - Rush University Medical CenterUttara Koul - Texas Health DallasJessica Laub - University of Rochester Medical CenterKaylee Maynard - Mayo ClinicRyan M. Naylor - University of New Mexico HospitalJoshua S. Newell - Rush University Medical CenterNicholas G. Panos - Denver Health Medical CenterLance Ray - University of Colorado DenverElizabeth Dee - Denver Health Medical CenterPreeyaporn Sarangarm - University of New Mexico HospitalAmy K. Sheldrake - University of KentuckySophie Shogren - University of IowaCierra N. Treu - New York City Health and Hospitals CorporationPaul Vantine - University of New Mexico HospitalJordan A. Woolum - University of Kentucky HealthCareEMPHARM-NET
- Resource Type
- Journal article
- Publication Details
- The American journal of emergency medicine, Vol.93, pp.126-131
- DOI
- 10.1016/j.ajem.2025.03.052
- PMID
- 40186945
- NLM abbreviation
- Am J Emerg Med
- ISSN
- 0735-6757
- eISSN
- 1532-8171
- Publisher
- Elsevier Inc
- Grant note
- Mayo Midwest Pharmacy Research Committee
Funding This study was partially funded by a grant from Mayo Midwest Pharmacy Research Committee.
- Language
- English
- Electronic publication date
- 03/28/2025
- Date published
- 07/2025
- Academic Unit
- Emergency Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984803712002771
Metrics
29 Record Views