Desmopressin for reversal of Antiplatelet drugs in Stroke due to intracerebral Haemorrhage 2 (DASH-2)

Background Intracerebral haemorrhage causes 3.4 million deaths per year. Outcome is worse in patients with intracerebral haemorrhage who are taking antiplatelets.

The number of people taking antiplatelets is rising but there is no effective treatment to reverse the effects of antiplatelet drugs after ICH. Desmopressin is a haemostatic drug that reduces bleeding after surgery in patients taking antiplatelet drugs.

We successfully conducted a feasibility trial assessing desmopressin for the reversal of antiplatelet drugs in intracerebral haemorrhage and are running Tranexamic acid for hyper acute spontaneous intracerebral haemorrhage (TICH-3) trial NIHR129917.

Tranexamic and desmopressin are commonly used in combination for the treatment of inherited bleeding disorders and the combination is recommended in national guidelines for platelet disorders.

Aims and objectives To assess whether desmopressin could reduce death or dependency for patients with intracerebral haemorrhage taking antiplatelet drugs.

Methods Overall research design: A multicentre, blinded, randomised trial of desmopressin compared to placebo for patients with intracerebral haemorrhage taking antiplatelet drugs.

The trial will be a randomised controlled comparison, in a partial factorial design, nested within the master protocol of the ongoing Tranexamic acid for hyper acute spontaneous intracerebral haemorrhage (TICH-3) trial.

The existing trial infrastructure of TICH-3 enables this desmopressin comparison to be conducted much more efficiently than a standalone trial. Setting: Sixty-five UK stroke centres participating in TICH-3.

Participant: Adults with intracerebral haemorrhage on imaging; < 24 hours from onset; taking antiplatelet drug; with verbal consent (patient or relative). Exclusions: Secondary causes of intracerebral haemorrhage; risk of fluid retention; systolic blood pressure