Abstract Number: PB1390
Meeting: ISTH 2020 Congress
Theme: Platelet Disorders and von Willebrand Disease » Antiplatelet Therapy
Background: Intracerebral haemorrhage causes approximately 3 million deaths worldwide per year. Pre-stroke antiplatelet drug use is associated with increased risk of death or disability.
Aims: To assess the feasibility of administering desmopressin or placebo to patients with antiplatelet associated intracerebral haemorrhage.
Methods: In the ongoing DASH trial, we aim to include 50 patients with spontaneous antiplatelet drug associated intracerebral haemorrhage, within 24 hours of symptom onset (figure 1). This time window was initially set at 12 hours but was increased on 01 December 2019 to maximise recruitment. Patients with capacity are approached for informed consent. A personal or professional legal nominee is approached for consent for patients who lack capacity (approved by East Midlands – Nottingham 2 research ethics committee [18/EM/0184]). Patients are randomised (1:1) to receive intravenous desmopressin 20 micrograms or matching placebo. Feasibility outcomes include proportion of patients approached being randomised, number of patients receiving allocated treatment, rate of recruitment, and adherence to treatment and follow up. Secondary outcomes include change in intracerebral haemorrhage volume at 24 hours; early mortality < 28 days, death or dependency at day 90, and serious adverse events up to day 90.
Results: 276 potential patients with intracerebral haemorrhage have been screened between 15 February 2019 and 28 January 2020 at 9 UK acute stroke centres. 20 patients (out of a planned 50 patients) have been recruited so far (table 1). Median time from symptom onset to administration of desmopressin or placebo was 5.1 hours (range 1.4 to 17.7 hours). The most common reasons patients were excluded were not being on an antiplatelet drug (133/256; 52%); presentation after the inclusion time window (38/256; 15%) or presentation at times when research staff were not available (29/256; 11%).
Conclusions: This is an ongoing feasibility trial, which will inform the design of a definitive trial.
Website: http://dash-1.ac.uk
Number of patients randomised N |
20 |
Age, years Mean (standard deviation) |
76.9 (10.3) |
Sex Male (%) |
11 (55.0) |
Pre-stroke modified Rankin Scale Median [interquartile range] |
0 [0, 3] |
Glasgow Coma Scale Median [interquartile range] |
15 [13, 15] |
Systolic blood pressure (mmHg) Mean (standard deviation) |
160.7 (23.7) |
Aspirin N (%) |
14 (70.0) |
Clopidogrel N (%) |
9 (45.0) |
History of Ischaemic stroke or transient ischaemic attack N (%) |
5 (25.0) |
History of ischaemic heart disease N (%) |
10 (50.0) |
[Table 1. Characteristics of participants in the DASH trial interim report.]
To cite this abstract in AMA style:
Desborough M, Al-Shahi Salman R, Stanworth S, Havard D, Brennan PM, Dineen R, Coats T, Johnson P, Hepburn T, Bath P, Sprigg N, DASH Trial Investigators . Desmopressin for Reversal of Antiplatelet Drugs in Stroke due to Haemorrhage (DASH): Interim Report on Recruitment from a Phase II Double Blind Randomised Controlled Trial [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/desmopressin-for-reversal-of-antiplatelet-drugs-in-stroke-due-to-haemorrhage-dash-interim-report-on-recruitment-from-a-phase-ii-double-blind-randomised-controlled-trial/. Accessed April 18, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/desmopressin-for-reversal-of-antiplatelet-drugs-in-stroke-due-to-haemorrhage-dash-interim-report-on-recruitment-from-a-phase-ii-double-blind-randomised-controlled-trial/