Therapeutic Role and Tolerability of Desmopressin in Preventing Hematoma Expansion Following Antiplatelet-related Intracerebral Hemorrhage: A Systematic Review and Meta-analysis
Hamza Hamid1, Umais Warraich1, Muhammad Ali Riaz1, Farhan Shahzad1, Syed Areeb Ahmed1, Faizan Shahzad1
1Rawalpindi Medical University
Objective:
The aim of this study was to assess the therapeutic role and safety of desmopressin for hematoma expansion in individuals with antiplatelet-associated intracranial hemorrhage (AA-ICH).
Background:
AA-ICH is a condition that is regarded as one of the most critical side effects in patients receiving antiplatelet treatment. Desmopression is a synthetic analog of ADH. It has shown inconsistent results with some studies indicating potential while others reporting no clinical benefit.
Design/Methods:

Three databases (PubMed, Cochrane, and Embase) were used to conduct a systematic search to find eligible studies comparing desmopressin (DDAVP) with 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 using Review Manager 5.4.1. The I2 test was used to measure heterogeneity, and the ROBINS-I was used to measure the risk of bias.

Results:

Six studies, containing a total of 603 patients, were included in the analysis. DDAVP was associated with a statistically insignificant decrease in hematoma expansion risk (RR=0.9, 95% CI= 0.59-1.37; P= 0.63, I2=52%). Thrombotic events also showed a statistically insignificant decrease in the DDAVP group (RR=0.69; 95% CI=0.26-1.81; P= 0.33, I2=14%). However, the risk of poor neurological outcomes showed a statistically significant increase in risk in patients on DDAVP (RR=1.36; 95% CI=1.06-1.76; P= 0.026, I2=25%). The studies showed a moderate to low level of risk of bias.

Conclusions:

Evidence indicates that DDAVP does not provide any significant advantage in preventing hematoma expansion. However, it could lead to poorer neurological outcome, which underlines the cautious use of this drug in clinical practice. Since most of the studies were retrospective in nature, future research should focus on multicenter prospective designs or well-conducted propensity-matched cohort studies. 

10.1212/WNL.0000000000215729
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