Desmopressin improves platelet activity in acute intracerebral hemorrhage.
Desmopressin improves platelet activity in acute intracerebral hemorrhage.
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DOI：
10.1161/strokeaha.114.006061
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发表时间：
2014-08
期刊：
影响因子：
8.3
通讯作者：
Kwaan HC
中科院分区：
文献类型：
--
作者：
Naidech AM;Maas MB;Levasseur-Franklin KE;Liotta EM;Guth JC;Berman M;Rosenow JM;Lindholm PF;Bendok BR;Prabhakaran S;Bernstein RA;Kwaan HC
最大限度地减少高危患者的血肿生长是改善脑出血后预后的一个有吸引力的策略。我们测试了这样的假设：去氨加压素 (DDAVP) 通过释放血管性血友病因子来改善止血，从而改善脑出血后的血小板活性。单独进行即时护理测试 (5)、已知单独使用阿司匹林 (1) 或两者 (8) 时血小板活性降低的患者接受去氨加压素 0.4 μg/kg IV 治疗。我们测量了血小板功能分析仪-肾上腺素（西门子公司，德国）和血管性血友病因子抗原，从基线到输注开始后1小时，以及从诊断到后续计算机断层扫描的血肿体积。我们招募了 14 名患者，平均年龄为 66.8±14.6 岁，其中 11 名 (85%) 为白人，8 名 (57%) 为男性。平均血小板功能分析仪-肾上腺素结果从治疗前的192±18秒缩短至1小时后的124±15秒（P=0.01），表明血小板活性得到改善。冯维勒布兰德因子抗原活性从242±96%增加至289±103%（P=0.004），表明冯维勒布兰德因子的预期增加。在脑出血症状出现后 12 小时内接受去氨加压素治疗的 7 名患者（50%）中，血肿体积变化不大，为 -0.5（-1.4 至 8.4）mL，并且只有 2 名患者血肿增大。一名患者出现低血压，另一名患者在服用去氨加压素后 6 小时内出现新的发烧。静脉注射去氨加压素耐受性良好，并能改善急性脑出血后的血小板活性。需要更大规模的研究来确定其与血小板输注或安慰剂相比对减少血肿生长的潜在影响。
Minimizing hematoma growth in high-risk patients is an attractive strategy to improve outcomes after intracerebral hemorrhage. We tested the hypothesis that desmopressin (DDAVP), which improves hemostasis through the release of von Willebrand factor, improves platelet activity after intracerebral hemorrhage. Patients with reduced platelet activity on point-of-care testing alone (5), known aspirin use alone (1), or both (8) received desmopressin 0.4 μg/kg IV. We measured Platelet Function Analyzer-epinephrine (Siemens AG, Germany) and von Willebrand factor antigen from baseline to 1 hour after infusion start and hematoma volume from the diagnostic to a follow-up computed tomographic scan. We enrolled 14 patients with of mean age 66.8±14.6 years, 11 (85%) of whom were white and 8 (57%) were men. Mean Platelet Function Analyzer-epinephrine results shortened from 192±18 seconds pretreatment to 124±15 seconds (P=0.01) 1 hour later, indicating improved plate activity. von Willebrand factor antigen increased from 242±96% to 289±103% activity (P=0.004), indicating the expected increase in von Willebrand factor. Of 7 (50%) patients who received desmopressin within 12 hours of intracerebral hemorrhage symptom onset, changes in hematoma volume were modest, −0.5 (−1.4 to 8.4) mL and only 2 had hematoma growth. One patient had low blood pressure and another had a new fever within 6 hours of desmopressin administration. Intravenous desmopressin was well tolerated and improved platelet activity after acute intracerebral hemorrhage. Larger studies are needed to determine its potential effects on reducing hematoma growth versus platelet transfusion or placebo.