Abstract 178: Desmopressin Increases Platelet Activity After Acute Intracerebral Hemorrhage
Background: Acute treatment for intracerebral hemorrhage (ICH) frequently centers on minimizing hematoma volume growth. Aspirin use or reduced platelet activity is a risk factor for hematoma growth and worse functional outcomes at 3 months. Many clinicians use platelet transfusion, although there are few data to support that practice. We tested the hypothesis that desmopressin, which reduces bleeding in the setting of aspirin use by increasing von Willebrand factor (wVF), would improve platelet activity in patients with ICH.
Methods: We prospectively screened patients with acute ICH for aspirin use or reduced platelet activity. The patient or a proxy was asked for consent for the administration of desmopressin 0.4 mcg/kg IV. The primary outcome was change in platelet activity, measured by the platelet function analyzer (PFA, Siemens AG, Germany), and vWF antigen, before and one hour after treatment. Parameters before and after treatment were compared with a paired t-test. We also prospectively documented acute adverse events. The FDA issued an exemption in response to a request for an IND. The study is registered at clinicaltrials.gov as NCT00961532.
Results: Twelve patients have been enrolled, of whom six were men, seven (58%) were Caucasian, and three (25%) were Hispanic. The PFA closure time decreased from 172 sec. (abnormal) to 134 seconds (normal), while vWF antigen increased from 214 to 256 percent of expected activity (both P<0.05). Desmopressin was well tolerated, with one patient each experiencing a new fever or hypotension.
Conclusions: In this pilot study, desmopressin seems to be relatively safe and well tolerated in patients with ICH, and increases platelet activity in vitro. Desmopressin may be a reasonable substitute for, or addition to, platelet transfusion to transiently increase platelet activity in patients with acute ICH.
Author Disclosures: A.M. Naidech: Research Grant; Modest; Northwestern Memorial Foundation. E.M. Liotta: None. J. Guth: None. B.R. Bendok: None. J. Rosenow: None. S. Prabhakaran: None. R.A. Bernstein: Research Grant; Modest; Boehringer Ingelheim, Medtronic, Pfizer-BMS, Athersys. Speakers' Bureau; Modest; Medtronic. Speakers' Bureau; Significant; Boehringer Ingelheim, BMS-Pfizer. Consultant/Advisory Board; Modest; Janssen. M.B. Maas: Research Grant; Significant; NIH-NINDS L30 NS080176. H.C. Kwaan: None.
- © 2014 by American Heart Association, Inc.