Lise Kjær Andersen1, Anne-Mette Hvas2, Christine Lodberg Hvas3. 1. Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark. 2. Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark. am.hvas@dadlnet.dk. 3. Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Abstract
BACKGROUND AND OBJECTIVE: An increasing number of patients receive antiplatelet therapy. Patients exposed to surgery while receiving platelet inhibitors hold an increased bleeding risk. Especially in neurosurgery and neurocritical care patients, bleeding and hematoma expansion are feared complications as even minor bleedings may be hazardous. The objective of this systematic review was to investigate the effect of desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP) on platelet function during antiplatelet therapy in patients undergoing non-cardiac surgery, patients who experience spontaneous or traumatic hemorrhage, healthy individuals and in animals. METHODS: Studies were identified through a systematic literature search in PubMed and EMBASE on August 19, 2019, with an update on May 2, 2020, and from reference lists of the included studies. Data on clinical and biochemical effect of DDAVP were extracted from included studies for a qualitative data synthesis. RESULTS: In total, 22 studies were included: 18 human studies and four animal studies. Overall, DDAVP improved bleeding time and increased platelet aggregation in patients undergoing non-cardiac surgery, patients suffering intracerebral or subarachnoid hemorrhage while receiving antiplatelet therapy as well as in healthy individuals and animals exposed to antiplatelet therapy. Observational data indicate that DDAVP may mitigate hematoma expansion in patients with intracerebral hemorrhage or traumatic brain injury. CONCLUSIONS: The present data hold biochemical evidence that DDAVP improves platelet function during antiplatelet therapy in humans and animals. The need for randomized trials is evident in order to evaluate the potential clinical effect of DDAVP in management of patients with spontaneous or traumatic hemorrhage, or undergoing neurosurgery, while receiving antiplatelet therapy.
BACKGROUND AND OBJECTIVE: An increasing number of patients receive antiplatelet therapy. Patients exposed to surgery while receiving platelet inhibitors hold an increased bleeding risk. Especially in neurosurgery and neurocritical care patients, bleeding and hematoma expansion are feared complications as even minor bleedings may be hazardous. The objective of this systematic review was to investigate the effect of desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP) on platelet function during antiplatelet therapy in patients undergoing non-cardiac surgery, patients who experience spontaneous or traumatic hemorrhage, healthy individuals and in animals. METHODS: Studies were identified through a systematic literature search in PubMed and EMBASE on August 19, 2019, with an update on May 2, 2020, and from reference lists of the included studies. Data on clinical and biochemical effect of DDAVP were extracted from included studies for a qualitative data synthesis. RESULTS: In total, 22 studies were included: 18 human studies and four animal studies. Overall, DDAVP improved bleeding time and increased platelet aggregation in patients undergoing non-cardiac surgery, patients suffering intracerebral or subarachnoid hemorrhage while receiving antiplatelet therapy as well as in healthy individuals and animals exposed to antiplatelet therapy. Observational data indicate that DDAVP may mitigate hematoma expansion in patients with intracerebral hemorrhage or traumatic brain injury. CONCLUSIONS: The present data hold biochemical evidence that DDAVP improves platelet function during antiplatelet therapy in humans and animals. The need for randomized trials is evident in order to evaluate the potential clinical effect of DDAVP in management of patients with spontaneous or traumatic hemorrhage, or undergoing neurosurgery, while receiving antiplatelet therapy.
Entities:
Keywords:
Aspirin; Bleeding; Desmopressin; Non-cardiac surgery; Platelet function
Authors: Craig D Williams; Andrew T Chan; Miriam R Elman; Alyson H Kristensen; W Fred Miser; Michael P Pignone; Randall S Stafford; Jessina C McGregor Journal: Am J Prev Med Date: 2015-05 Impact factor: 5.043
Authors: Jennifer A Frontera; John J Lewin; Alejandro A Rabinstein; Imo P Aisiku; Anne W Alexandrov; Aaron M Cook; Gregory J del Zoppo; Monisha A Kumar; Ellinor I B Peerschke; Michael F Stiefel; Jeanne S Teitelbaum; Katja E Wartenberg; Cindy L Zerfoss Journal: Neurocrit Care Date: 2016-02 Impact factor: 3.210
Authors: Sibylle A Kozek-Langenecker; Aamer B Ahmed; Arash Afshari; Pierre Albaladejo; Cesar Aldecoa; Guidrius Barauskas; Edoardo De Robertis; David Faraoni; Daniela C Filipescu; Dietmar Fries; Thorsten Haas; Matthias Jacob; Marcus D Lancé; Juan V L Pitarch; Susan Mallett; Jens Meier; Zsolt L Molnar; Niels Rahe-Meyer; Charles M Samama; Jakob Stensballe; Philippe J F Van der Linden; Anne J Wikkelsø; Patrick Wouters; Piet Wyffels; Kai Zacharowski Journal: Eur J Anaesthesiol Date: 2017-06 Impact factor: 4.330
Authors: Crispijn L van den Brand; Tanya Tolido; Anna H Rambach; Myriam G M Hunink; Peter Patka; Korné Jellema Journal: J Neurotrauma Date: 2016-05-09 Impact factor: 5.269
Authors: Rolf Rossaint; Bertil Bouillon; Vladimir Cerny; Timothy J Coats; Jacques Duranteau; Enrique Fernández-Mondéjar; Daniela Filipescu; Beverley J Hunt; Radko Komadina; Giuseppe Nardi; Edmund A M Neugebauer; Yves Ozier; Louis Riddez; Arthur Schultz; Jean-Louis Vincent; Donat R Spahn Journal: Crit Care Date: 2016-04-12 Impact factor: 9.097