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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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The use of desmopressin acetate in intracranial haemorrhage

Meeting Abstract

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  • S. Röhrer - Neurochirurgische Klinik, Universitätsklinikum Ulm, Ulm
  • C.R. Wirtz - Neurochirurgische Klinik, Universitätsklinikum Ulm, Ulm
  • S. Struve - Sektion Hämostaseologie, Innere Klinik IIII, Universitätsklinikum Ulm, Ulm
  • B. Schmitz - Sektion Neuroradiologie, Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Ulm, Ulm
  • D. Woischneck - Neurochirurgische Klinik, Klinikum Landshut, Landshut
  • T. Kapapa - Neurochirurgische Klinik, Universitätsklinikum Ulm, Ulm

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.06.09

doi: 10.3205/11dgnc037, urn:nbn:de:0183-11dgnc0378

Published: April 28, 2011

© 2011 Röhrer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Physicians are engaged to refer all undesirable drug actions to their pharmaceutical committee at German Medical Fraternity. Frequencies of neurosurgical relevant intracranial haemorrhages due to acetylsalicylic acid are unknown. Surgical procedures are done with high intra- and postoperative risk of rebleeding, especially in emergency situations. The improvement of coagulation due to desmopressin acetate after usage of acetylsalicylic acid is presented.

Methods: In a prospective manner, the thrombocyte function after intracranial haemorrhage with usage of acetylsalicylic acid was tested while admittance (t0). In case of urgent intervention the dose of 24 µg desmopressin acetate is given intravenous. The function of thrombocytes is tested anew after 30 minutes (t1) and 3 hours (t2). The time needed to block a coated bio-active membrane (EpinephrinTest1 or ADPTest2) by a thrombus is determined. Patients with singular (PatS) and multiple (PatM) usage of acetylsalicylic acid are distinguished. Statistical calculations were done with p≤0.05.

Results: Thrombocyte function is tested in 18 patients that are admitted due to spontaneous subarachnoid haemorrhage (N=7), spontaneous intracerebral haemorrhage (N=4), traumatic brain injuries (N=3) and chronic subdural haematoma (N=4). Proportions of groups are: PatM N=10, PatS N=8. 1. PatM are showing a t0-value with more than 300 seconds. PatS have mean values of 180 sec. (test 1) and 100 sec. (test 2) (p=0.001). 2. Thrombocyte function can be normalized in both groups at t1 after application of desmopressin acetate. 3. Thrombocyte function was anew impaired at t2 in both groups. However, PatM have worse values (p=0,002). 4. There is no evidence of intraoperative bleeding complication or disturbances in water- and electrolyte-balance.

Conclusions: The application of 24 µg desmopressin acetate intravenous is able to normalize the thromboyte function after usage of acetylsalicylic acid, independently to duration of use. Desmopressinacetate is a fast and save option to normalize thrombocyte function before surgical procedures. However, monitoring of coagulation is still needed due to impaired coagulation after three hours after application. The effect of additive administration of thrombocyte-concentrates is to investigate. Desmopressin acetate is reducing the risk of bleeding complications in context with acetylsalicylic acid.