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Desmopressin (DDAVP) and Platelet Transfusion to Mitigate the Effects of Pre-Injury Antiplatelet Agents in Traumatic Brain Injury2022

Type: New Practice Management Guideline (PMG)
Category: Trauma
Committee Liaison: Rachel D. Appelbaum, MD

Team leader(s)

Antiplatelet agents are commonly prescribed medications that are associated with worse outcomes in traumatic brain injury (TBI). By definition, there are no available medications to "reverse" the effects of these irreversible agents. The use of
Desmopressin (DDAVP) to mitigate the effects of antiplatelet agents in TBI is supported by some observational studies that suggest this medication may halt progression of intra-cranial hemorrhage. While this practice is supported by the Neurocritical Care Society, there is inconsistent use of this medication across trauma centers. In addition, many trauma practitioners transfuse platelets in these circumstances, a practice not supported in the literature. Currently, to our knowledge, there are no trauma-specific guidelines from major societies (WTA, COT, EAST, AAST) that address the use of DDAVP, TEG with platelet mapping, and platelet transfusion in TBI. The risk of a single dose of DDAVP appears very low in the literature, and this medication is relatively inexpensive. A guideline to address this very common problem has the potential to positively impact a large number of patients with relatively simple recommendations.

Team members:
• Michael Vella, MD (Team leader)
• Julius D. Cheng, MD, MPH (Team leader)
• Majed Refaai, MD
• Lucy Kornblith, MD
• Victoria Miles, MD
• Ida Molavi, MD
• Ryan P. Dumas, MD
• Linda Dultz, MD, MPH, FACS
• Brittany Bankhead, MD, MS
• Bellal Joseph, MD, FACS
• Elliott R. Haut, MD, PhD, FACS
• Milos Buhavac, MD
•Robyn Richmond, MD
•Debra Roberts, MD
•Stephen Figueroa, MD
•Matthew Kutcher, MD
•Michael Luca, DO

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