The Role of Desmopressin on Hematoma Expansion in Patients with Mild Traumatic Brain Injury Prescribed Pre-injury Antipl
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ORIGINAL WORK
The Role of Desmopressin on Hematoma Expansion in Patients with Mild Traumatic Brain Injury Prescribed Pre‑injury Antiplatelet Medications Jeffrey F. Barletta1* , Diana Abdul‑Rahman2, Scott T. Hall3, Alicia J. Mangram4, James K. Dzandu4, Jennifer A. Frontera5 and Victor Zach2,6 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background/Objective: Desmopressin (DDAVP) has been suggested for antiplatelet medication reversal in patients with traumatic brain injury (TBI) but there are limited data describing its effect on clinical outcomes. The purpose of this study was to evaluate the effect of DDAVP on hematoma expansion and thrombosis in patients with TBI who were prescribed pre-injury antiplatelet medications. Methods: Consecutive adult patients who were admitted to our level I trauma center and prescribed pre-injury antiplatelet medications between July, 2012, and May, 2018, were retrospectively identified. Patients were excluded if their hospital length of stay was 33% from baseline or a new hematoma was reported. Hematoma expansion was determined through review of CT scans and interpreted by a specialty-certified neurointensivist. Two separate neurointensivists confirmed all hematoma expansions. Both were blinded to the use of DDAVP when interpreting CT scans. Hematoma size was calculated using the “ABC/2” method for patients with ICH, epidural hematoma (EDH) or subdural hematoma (SDH) [15–17]. For patients with multi-compartmental bleeds, if more than one type of hemorrhage expanded, the largest hemorrhage was rated for hematoma expansion. The secondary outcome was DDAVP-associated thrombosis, which was defined as a thrombotic complication occurring within 48 h of DDAVP administration or admission (if DDAVP not administered). Thrombotic adverse drug events were further stratified by pathophysiology as arterial (e.g., myocardial infarction, cerebrovascular accident) or venous (e.g., deep vein thrombosis, pulmonary embolism). Patients were stratified into two groups based on the administration of DDAVP (yes or no). From July 2012 to October 2014, the use of DDAVP was not standardized and prescribed as per physician discretion. After October 2014, a protocol was implemented that included a single dose of intravenous DDAVP 0.3 mcg/kg for patients with TBI taking pre-injury antiplatelet medications. Following
collection of the aforementioned data, demographics, injury type and severity and treatment outcomes were compared between groups. To control for confounding variables and differences at baseline between the two groups, a univariate analysis was performed using any hematoma expansion as the dependent variable and associated factors were identified. Following univariate analysis, a multivariate analysis was performed and risk factors for hematoma expansion were identified. The multivariate model was built by identifying factors on univariate analysis with a p value 0.05; c-statistic = 0.750). Subgroup analysis revealed the benef
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