Desmopressin Acetate in Intracranial Haemorrhage

Kapapa, Thomas; Röhrer, Stefan; Struve, Sabine; Petscher, Matthias; König, Ralph; Wirtz, Christian Rainer; Woischneck, Dieter

doi:10.1155/2014/298767

Cited by 51 publications

(25 citation statements)

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“…The standard dose is 0.3 μg/kg diluted in 50 ml saline and infused over 30 min [ 564 ]. Recently, two small prospective studies have shown that desmopressin can improve platelet function in patients with ICH who have received aspirin [ 567 ] or not [ 568 ] prior to the event. Identification of impaired platelet function with a platelet function analyser PFA-100 [ 559 ] or whole blood MEA [ 560 ] might be helpful in the identification of patients who could benefit from desmopressin therapy.…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

et al. 2016

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BackgroundSevere trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution.MethodsThe pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013.ResultsThe guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome.ConclusionsA multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1265-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

et al. 2016

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“…Desmopressin (0.4 μg/kg IV given over 30 minutes) increased platelet activity, as measured by von Willebrand factor antigen and closure times (PFA-100 with epinephrine), 1 hour after DDAVP administration. The DDAVP effect may be short lived, however, and platelet function abnormalities may return within 3 hours [ 110 ]. Based on these limited data, a single dose of DDAVP (0.4 μg/kg IV given over 30 minutes) may be considered for patients with aspirin-associated, COX-1 inhibitor-associated, or ADP receptor inhibitor-associated ICH.…”

Section: Medical Management Of Ichmentioning

confidence: 99%

The critical care management of spontaneous intracranial hemorrhage: a contemporary review

et al. 2016

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Spontaneous intracerebral hemorrhage (ICH), defined as nontraumatic bleeding into the brain parenchyma, is the second most common subtype of stroke, with 5.3 million cases and over 3 million deaths reported worldwide in 2010. Case fatality is extremely high (reaching approximately 60 % at 1 year post event). Only 20 % of patients who survive are independent within 6 months. Factors such as chronic hypertension, cerebral amyloid angiopathy, and anticoagulation are commonly associated with ICH. Chronic arterial hypertension represents the major risk factor for bleeding. The incidence of hypertension-related ICH is decreasing in some regions due to improvements in the treatment of chronic hypertension. Anticoagulant-related ICH (vitamin K antagonists and the newer oral anticoagulant drugs) represents an increasing cause of ICH, currently accounting for more than 15 % of all cases. Although questions regarding the optimal medical and surgical management of ICH still remain, recent clinical trials examining hemostatic therapy, blood pressure control, and hematoma evacuation have advanced our understanding of ICH management. Timely and aggressive management in the acute phase may mitigate secondary brain injury. The initial management should include: initial medical stabilization; rapid, accurate neuroimaging to establish the diagnosis and elucidate an etiology; standardized neurologic assessment to determine baseline severity; prevention of hematoma expansion (blood pressure management and reversal of coagulopathy); consideration of early surgical intervention; and prevention of secondary brain injury. This review aims to provide a clinical approach for the practicing clinician.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1432-0) contains supplementary material, which is available to authorized users.

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“…Platelet transfusion and coadministration of DDAVP has not been associated with a decreased risk of hemorrhage progression or mortality. In a prospective study, 14 DDAVP was administered to 10 patients with ICH who had been receiving ASA, and platelet function was improved; this effect was short-lived and not statistically significant. Naidech et al 15 reported a study in patients with spontaneous intracerebral hematoma and reduced platelet activity.…”

Section: Treatmentmentioning

confidence: 99%

Management Dilemmas in Patients with Traumatic Brain Injury on Anticoagulants

Srinivas

Deora

2020

Indian Journal of Neurotrauma

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Introduction A normal individual with normal hemostasis maintains a balance between thrombus formation and destruction using a complex interaction between the smooth vascular endothelium, the coagulation cascade, the platelet aggregation system, and the fibrinolysis mechanism. However, in patients who are on either antiplatelet drugs (APDs) or anticoagulants (ACDs), this normal homeostasis is altered. This is further altered with traumatic brain injury (TBI) and thus, we need specific guidelines to address this subpopulation to decide the length of observation, avoid unnecessary hospitalization, and relieve the economic burden. There exists a very few randomized controlled trials (RCTs) for this clinical question and a thorough risk–benefit analysis for each patient is prudent before making clinical decisions. Materials and Methods This is a review article based on available evidence published in literature. Results There are multiple therapeutic drugs which act on various stages of the coagulation mechanism. These include antiplatelet agents, Vitamin K antagonists, Heparin, Antithrombin III, and Glycoprotein IIb/IIIA inhibitors. While the initial management of head injuries depends on the severity of head injuries, management of head injuries in patients on anticoagulants needs to be approached with care and caution. There are multiple dilemmas including role of CT scans, duration and reason for admission, when to restart anticoagulation, etc. We suggest the recommendations based on available literature; however, no evidence can be given as these are not based on any RCTs, due to paucity of such studies. Conclusion The guidelines are based on previously conducted trials and consensus. We have attempted to provide a pragmatic and practical approach to such cases with the hope that it will ensure minimum risks with the best possible patient outcomes. The entire journey from patient presentation to follow-up has been covered in this article and we hope this would be useful to all practicing in the field of neurotrauma.

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Desmopressin Acetate in Intracranial Haemorrhage

Cited by 51 publications

References 25 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

The critical care management of spontaneous intracranial hemorrhage: a contemporary review

Management Dilemmas in Patients with Traumatic Brain Injury on Anticoagulants

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