A multicenter retrospective study evaluating the impact of desmopressin on hematoma expansion in patients with antiplatelet-associated intracranial hemorrhage

Summers, Amanda; Singh, Jasmeet; Lai, Michelle; Schomer, Kendra J.; Martin, Ryan C.; Vitt, Jeffrey R.; Derry, Katrina; Box, Kevin; Chu, Francis; Arias, Valerie; Minokadeh, Anushirvan; Stern‐Nezer, Sara; Groysman, Leonid; Lee, Benjamin J.; Atallah, Steven

doi:10.1016/j.thromres.2022.12.016

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…Summers et al. ( 2023 ) noted that although recommended by SCCM guidelines (Society of Critical Care Medicine Guidelines (SCCMC)), DDAVP warrants scrutiny to establish its efficacy in mitigating this expansion risk. The study's findings indicate similar expansion rates between DDAVP and non‐DDAVP groups.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of desmopressin (DDAVP) in preventing hematoma expansion in intracranial hemorrhage associated with antiplatelet drugs use: A systematic review and metaanalysis

Shahzad,

Ahmed,

Muhammad

et al. 2024

Brain and Behavior

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IntroductionOne of the most serious complications associated with antiplatelet agents is antiplatelet‐associated intracranial hemorrhage (AA‐ICH). Desmopressin is a synthetic antidiuretic hormone (ADH) analog. It has been linked to improving patient outcomes in antiplatelet‐induced intracranial hemorrhage. The secondary outcomes included the incidence of thrombotic complications and neurological outcomes.MethodsA systematic search was conducted on three databases (PubMed, Cochrane, and ClinicalTrials.gov) to find eligible literature that compares desmopressin (DDAVP) versus 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 (CI). Heterogeneity was measured using the I2 test. The risk of bias in studies was calculated using the New Castle Ottowa Scale.ResultsFive studies were included in the analysis with a total of 598 patients. DDAVP was associated with a nonsignificant decrease in the risk of hematoma expansion (RR = .8, 95% CI,.51–1.24; p = .31, I2 = 44%). It was also associated with a non‐significant decrease in the risk of thrombotic events (RR,.83; 95% CI,.25–2.76; p = .76, I2 = 30%). However, patients in the DDAVP group demonstrated a significant increase in the risk of poor neurological outcomes (RR, 1.31; 95% CI, 1.07–1.61; p = .01, I2 = 0%). The risk of bias assessment showed a moderate to low level of risk.ConclusionDDAVP was associated with a nonsignificant decrease in hematoma expansion and thrombotic events. However, it was also associated with a significantly poor neurological outcome in the patients. Thus, until more robust clinical trials are conducted, the use of DDAVP should be considered on a case‐to‐case basis.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of desmopressin (DDAVP) in preventing hematoma expansion in intracranial hemorrhage associated with antiplatelet drugs use: A systematic review and metaanalysis

Shahzad,

Ahmed,

Muhammad

et al. 2024

Brain and Behavior

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“…Several other retrospective studies have similarly concluded that DDAVP use was safe but provided no benefit and was not associated with a decrease in hematoma expansion in patients with ICH. [10][11][12] One retrospective study reported a decrease in hematoma expansion, but this was limited to the first 24 hours of treatment as the researchers only looked at the first 24 hours as their primary endpoint. 13 A single-center, nonrandomized study of patients with spontaneous ICH on antiplatelet therapy who received combined desmopressin and platelet transfusion had results in line with the PATCH 9 trial: there was no benefit found with early platelet transfusion, and desmopressin failed to decrease hematoma expansion or improve functional outcome.…”

Section: Desmopressinmentioning

confidence: 99%

Ultra-Early Hemostatic Therapy for Acute Intracerebral Hemorrhage: An Updated Review

Fortunato,

Subah,

Thomas

et al. 2024

Cardiology in Review

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Intracerebral hemorrhage (ICH) is the second most common type of stroke, accounting for approximately 10–20% of all strokes, and is linked to severe neurological disability and death. Since the most accurate predictor of outcome in patients with ICH is hematoma volume, there is a great need for pharmacologic therapy that can reduce hematoma expansion and resultant mass effect and edema. This is especially critical within the ultra-early window of 3–4 hours after the presentation. Hemostatic therapies are exceptionally important for those patients taking antiplatelet or anticoagulant medications to reverse the effects of these medications and therefore prevent hematoma expansion. Furthermore, the recent publication of the 2023 Guideline for the Management of Patients with Aneurysmal Subarachnoid Hemorrhage by the American Heart Association/American Stroke Association, the first update to the guidelines since 2012, underscores the importance of optimizing anticoagulation reversal for this population. The purpose of this selective, nonsystematic review is to examine current literature regarding the use of hemostatic therapies in ICH, with particular attention paid to antiplatelet, anticoagulation, and antifibrinolytic therapies.

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“…A multicenter, retrospective study published by Summers and colleagues highlighted the cross-site connections made through collaboration. 9 Three sites had differing practices of guideline-recommended utilization of desmopressin for intracranial hemorrhage secondary to antiplatelet use. 10,11 2 represents limited projects and successes of our collaborative team.…”

Section: Formulary and Operational Efficienciesmentioning

confidence: 99%

“…The pre‐built collaborative framework further enables connections for studies where variable practice methodologies or small sample size prohibit research. A multicenter, retrospective study published by Summers and colleagues highlighted the cross‐site connections made through collaboration 9 . Three sites had differing practices of guideline‐recommended utilization of desmopressin for intracranial hemorrhage secondary to antiplatelet use 10,11 .…”

Section: Benefits Of Creating a Collaborative Work Groupmentioning

confidence: 99%

Creation and execution of an effective critical care pharmacist collaborative in an academic health system

Derry,

Duby,

Firestone

et al. 2023

J Am Coll Clin Pharm

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Hospital systems continue to face significant pressure to mitigate medication costs, which may be achieved by effective pharmacy collaboration between medical centers. The purpose of this narrative is to discuss the essential elements, methods, obstacles, and solutions that were encountered in the formation and function of a successful multicenter pharmacy collaborative. The objective is to share the tools and examples that illustrate the framework and mechanics employed by a collaborative to execute initiatives that improved patient care and institutional processes. In 2018, five academic medical centers (AMCs) formed a critical care pharmacy collaborative team (PCT). The group's sustainable leadership structure allowed for equal voicing while avoiding individual burnout. Focused monthly working meetings allowed for comparison of each AMC's best practices to identify unexplored practice gaps and project planning. System goals with standardized metrics were set and parallel institutional approaches were implemented. Pooling use experience from five AMCs allowed for a larger sample size for data evaluation to assist in management of high impact medications. Additional benefits of group collaboration extended to research opportunities and incorporation of pharmacy learners for practice‐based learning. During this journey, barriers were uncovered including inconsistent access to a centralized secure platform for information sharing, data collection and analysis, overreliance of responsibilities on few individuals, and unpredictable dedicated project time for team leads and members. Overall, pharmacist led stewardship projects across five AMCs were leveraged to advance patient care through increased clinical guideline adherence, operational efficiency, and medication cost savings.

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A multicenter retrospective study evaluating the impact of desmopressin on hematoma expansion in patients with antiplatelet-associated intracranial hemorrhage

Cited by 8 publications

References 20 publications

Safety and efficacy of desmopressin (DDAVP) in preventing hematoma expansion in intracranial hemorrhage associated with antiplatelet drugs use: A systematic review and metaanalysis

Safety and efficacy of desmopressin (DDAVP) in preventing hematoma expansion in intracranial hemorrhage associated with antiplatelet drugs use: A systematic review and metaanalysis

Ultra-Early Hemostatic Therapy for Acute Intracerebral Hemorrhage: An Updated Review

Creation and execution of an effective critical care pharmacist collaborative in an academic health system

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