Desmopressin improves platelet activity in acute intracerebral hemorrhage

Abstract

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.

Keywords: blood platelets; cerebral hemorrhage; deamino arginine vasopressin.

© 2014 American Heart Association, Inc.

Figures

Figure 1.

Flowchart of screening and enrollment in the study. INR indicates international normalized ratio.

Figure 2.

Change in the Platelet Function Analyzer (PFA)-epinephrine (EPI) from baseline to 1 hour after start of desmopressin infusion. Baseline PFA-EPI results shortened from 192±18 to 124±15 seconds (P=0.01) 1 hour later, consistent with a resolution of aspirin effect. One patient had increased PFA-EPI closure time after treatment but no hematoma growth.