Efficacy and Safety of Desmopressin and Platelet Transfusions in Patients With Antiplatelet-Associated Intracranial Hemorrhage

Antiplatelet medications, such as aspirin and P2Y12 inhibitors, are commonly utilized for primary and secondary prevention of cardiovascular and cerebrovascular events. However, antiplatelets are associated with an increased risk of bleeding, including both spontaneous and traumatic intracranial hemorrhage (ICH). The two most utilized agents for antiplatelet reversal include desmopressin (DDAVP) and platelets. Data for the use of DDAVP as an antiplatelet reversal agent is largely derived from small, retrospective cohort studies, and its impact on patient outcomes is controversial. Current guidelines recommend against the use of platelet transfusions for reversal unless the patient is undergoing neurosurgical intervention. Despite this, platelet transfusions are commonly utilized as a reversal agent for antiplatelets in the setting of ICH. The objective of this study was to determine the impact of DDAVP plus platelet transfusions versus DDAVP alone on the efficacy and safety of patients with antiplatelet-associated ICH.

This single center, retrospective, chart review study included patients > 18 years of age that received DDAVP for antiplatelet-associated ICH from April 1, 2016 to May 31, 2025. The primary endpoint was increase in hematoma expansion at four hours. Secondary endpoints included increase in hematoma expansion at 24 hours, patient disposition, in-hospital mortality, hospital length of stay, and intensive care unit (ICU) length of stay (LOS). Secondary safety endpoints included thrombotic events and hyponatremia.

These findings are preliminary and have not undergone formal statistical analysis. A total of 311 patients were screened for eligibility, and 66 were included in the primary analysis. The majority of patients presented with traumatic ICH and received DDAVP within guideline-recommended dosing parameters. Hematoma expansion at 4 hours occurred in 34.5% of patients that received DDAVP plus platelets compared to 9.1% that received DDAVP alone. In-hospital mortality occurred in 30.9% of patients that received DDAVP plus platelets compared to 27.2% that received DDAVP alone. Median ICU LOS was 6.0 days in patients that received DDAVP plus platelets and 3.5 days in those that received DDAVP alone.

Final results and conclusions will be presented at the conference.