Title : Desmopressin in antiplatelet-associated spontaneous intracerebral hemorrhage: A systematic review and meta-analysis
Abstract:
Background: Desmopressin (DDAVP) has been proposed as a hemostatic adjunct in antiplatelet-associated intracerebral hemorrhage (ICH), yet evidence remains limited. Shahzad et al. [1] pooled 5 studies (598 patients) and found no reduction in hematoma expansion (HE) but significantly worse neurological outcomes (RR 1.31, p=0.01). We performed an updated review with expanded study inclusion.
Methods: PubMed, Embase, and Cochrane were searched through March 2025, yielding 412 records. After duplicate removal and screening, 9 studies (2,406 patients) were included. Six studies with extractable HE data were pooled using DerSimonian-Laird random-effects odds ratios (OR).
Results: Included studies comprised one RCT [2], seven retrospective cohorts [3–9], and one prospective cohort [10]. Pooled OR for HE was 0.76 (95% CI 0.41–1.42, p=0.39; I²=56.5%), favoring DDAVP but not reaching significance. Feldman et al. [3] showed the largest effect (OR 0.22, p=0.002). Functional outcomes trended favorably: mRS>4 in 22% vs 37% (DASH trial [2]) and 16.2% vs 29.1% poor outcomes in matched pairs [5]. No increase in thrombotic events or hyponatremia was observed.
Discussion: Compared with Shahzad et al. [1], we include 4 additional studies [4,8–10] and quadruple the sample size. We did not replicate their adverse neurological finding, likely attributable to confounding by indication in unadjusted data. Our inclusion of propensity-matched and IPTW-adjusted analyses [5,8,9] mitigates this bias.
Conclusion: DDAVP shows a non-significant trend toward reduced HE with an acceptable safety profile in antiplatelet-associated ICH. Larger randomized trials are warranted.
