Desmopressin improves platelet activity in acute intracerebral hemorrhage.
BACKGROUND AND PURPOSE
Minimizing hematoma growth in high-risk patients is an attractive strategy to improve outcomes after intracerebral hemorrhage. We tested the hypothesis that desmopressin (DDAVP), which improves hemostasis through the release of von Willebrand factor, improves platelet activity after intracerebral hemorrhage.


METHODS
Patients with reduced platelet activity on point-of-care testing alone (5), known aspirin use alone (1), or both (8) received desmopressin 0.4 μg/kg IV. We measured Platelet Function Analyzer-epinephrine (Siemens AG, Germany) and von Willebrand factor antigen from baseline to 1 hour after infusion start and hematoma volume from the diagnostic to a follow-up computed tomographic scan.


RESULTS
We enrolled 14 patients with of mean age 66.8±14.6 years, 11 (85%) of whom were white and 8 (57%) were men. Mean Platelet Function Analyzer-epinephrine results shortened from 192±18 seconds pretreatment to 124±15 seconds (P=0.01) 1 hour later, indicating improved plate activity. von Willebrand factor antigen increased from 242±96% to 289±103% activity (P=0.004), indicating the expected increase in von Willebrand factor. Of 7 (50%) patients who received desmopressin within 12 hours of intracerebral hemorrhage symptom onset, changes in hematoma volume were modest, -0.5 (-1.4 to 8.4) mL and only 2 had hematoma growth. One patient had low blood pressure and another had a new fever within 6 hours of desmopressin administration.


CONCLUSIONS
Intravenous desmopressin was well tolerated and improved platelet activity after acute intracerebral hemorrhage. Larger studies are needed to determine its potential effects on reducing hematoma growth versus platelet transfusion or placebo.


CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT00961532.
['Naidech|Andrew M|AM|', 'Maas|Matthew B|MB|', 'Levasseur-Franklin|Kimberly E|KE|', 'Liotta|Eric M|EM|', 'Guth|James C|JC|', 'Berman|Micheal|M|', 'Rosenow|Joshua M|JM|', 'Lindholm|Paul F|PF|', 'Bendok|Bernard R|BR|', 'Prabhakaran|Shyam|S|', 'Bernstein|Richard A|RA|', 'Kwaan|Hau C|HC|']
D000368:Aged D000369:Aged, 80 and over D001792:Blood Platelets D002543:Cerebral Hemorrhage D003894:Deamino Arginine Vasopressin D005260:Female D006490:Hemostatics D006801:Humans D008297:Male D008875:Middle Aged D010979:Platelet Function Tests D011446:Prospective Studies D016896:Treatment Outcome D014841:von Willebrand Factor
blood platelets cerebral hemorrhage deamino arginine vasopressin