Dados do Trabalho

Título

Desmopressin for patients with anti-platelet associated intracranial hemorrhage: a systematic review and updated meta-analysis

Objetivo

We aimed to perform an updated meta-analysis to assess the efficacy and safety of desmopressin for intracranial bleeding associated with antiplatelet therapy.

Métodos

PubMed, Embase, and Cochrane databases were searched for randomized and observational studies. A random effects model was used for the data analysis. Heterogeneity was examined with the Tau square tool and I² statistics. P-values < 0.05 were considered statistically significant. R software was used for statistical analysis. Baujat plot was conducted to assess high heterogeneity.

Resultados

A total of 10 studies with a cohort of 1,156 patients were included, of whom 582 underwent treatment with desmopressin. No significant differences were found regarding the following outcomes 1) Hematoma expansion ≥ 33% (20% vs. 23%; RR 0.89; 95% CI 0.56–1.43; p=0.631; I²=0%) and 2) Mortality (8% vs. 10%; OR 0.99; 95% CI 0.43–2.24; p=0.972; I²=57%). Statistical difference was found in 1) MRS ≥ 4 (63% vs. 51%; OR 1.75; 95% CI 1.06–2.90; p=0.02; I²=14%) and 2) Discharge to rehab (32% vs. 21%; RR 1.44; 95% CI 1.09–1.90; p=0.01; I²=0%). Although clear sources of between-studies heterogeneity were identified, the variances did not account for substantial changes in the observed effect.

Conclusão

Despite recommendations from numerous guidelines based on limited evidence from small cohorts and a few randomized studies, most outcomes did not reach statistical significance when combined in a pooled analysis.