Abstract Number: PB0852
Meeting: ISTH 2021 Congress
Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » Antiplatelet Therapy
Background: Intracerebral haemorrhage caused approximately 3 million deaths worldwide in 2015. Pre-stroke antiplatelet drug use is associated with a 27% relative increase in one-month case fatality compared to patients not using antithrombotic drugs.
Aims: We aim to assess the feasibility of administering desmopressin or placebo to patients with antiplatelet associated intracerebral haemorrhage to inform the design of a definitive trial.
Methods: In the ongoing DASH trial, we aim to include 50 patients within 24 hours of spontaneous intracerebral haemorrhage onset, associated with oral antiplatelet drug(s) use in the preceding seven days (figure 1). This time window was initially set at 12 hours but was increased on 01 December 2019 to maximise recruitment. Patients are randomised (1:1) to receive intravenous desmopressin 20 ug in 50 ml sodium chloride 0.9% infused over 20 minutes 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, serious adverse events up to day 90.
Results:
Number of patients randomised N |
34 | |
Age, years Mean (standard deviation) |
76.9 (10.3) | |
Sex Male (%) |
20 (59.0) | |
Time from symptom onset to randomisation (hours) Median [interquartile range] |
9 [4, 17] | |
Pre-stroke modified Rankin Scale Median [interquartile range] |
1 [0, 2] | |
Glasgow Coma Scale Median [interquartile range] |
15 [13, 15] | |
Systolic blood pressure (mmHg) Mean (standard deviation) |
156 (22.9) | |
Aspirin N (%) |
23 (68) | |
Clopidogrel N (%) |
14 (41) | |
Dipyridamole N (%) |
1 (3) |
522 potential patients with intracerebral haemorrhage have been screened between 15 February 2019 and 15 January 2021 at 10 UK acute stroke centres. 34 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 9 hours (interquartile range 4 to 17 hours). The most common reasons patients were excluded were not being on an antiplatelet drug (268/522; 51%); presentation after the inclusion time window (62/522; 12%) or presentation at times when research staff were not available (49/522; 9%).
Conclusions: This is an ongoing feasibility trial, which will inform the design of a definitive trial.
http://dash-1.ac.uk
To cite this abstract in AMA style:
Desborough M, Al-Shahi Salman R, Stanworth S, Havard D, M Brennan P, Dineen R, Coats T, Hepburn T, Woodhouse L, Bath P, Sprigg N. Desmopressin for Reversal of Antiplatelet Drugs in Stroke due to Haemorrhage (DASH): Second Interim Report on Recruitment from a Phase II Double Blind Randomised Controlled Trial [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/desmopressin-for-reversal-of-antiplatelet-drugs-in-stroke-due-to-haemorrhage-dash-second-interim-report-on-recruitment-from-a-phase-ii-double-blind-randomised-controlled-trial/. Accessed March 21, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/desmopressin-for-reversal-of-antiplatelet-drugs-in-stroke-due-to-haemorrhage-dash-second-interim-report-on-recruitment-from-a-phase-ii-double-blind-randomised-controlled-trial/