TRAUMA
Desmopressin in Traumatic Intracranial Hemorrhage: Don’t PATCH the Leak— Dose Matters By Aubrey Evers, PharmD; Zachary Senger, PharmD; and Justin Reinert, PharmD, MBA
SAEM PULSE | MAY-JUNE 2026
At a Glance
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• Why this matters now: Antiplatelet-associated intracranial hemorrhage remains a high-risk, time-sensitive emergency where optimal reversal strategies are still evolving. • What you’ll learn: How desmopressin works, what the evidence shows, and why weight-based dosing may be more effective than fixed-dose approaches.
• Who this is for: Emergency physicians, pharmacists, and trainees making real-time decisions about bleeding management in intracranial hemorrhage.
Background
Traumatic intracranial hemorrhage (ICH) remains one of the most timesensitive and high-stakes conditions in emergency care. For patients taking antiplatelet therapy, even brief delays in achieving hemostasis
can lead to hematoma expansion, neurologic deterioration, and longterm disability. Limiting bleeding is associated with improved survival and functional outcomes. Platelet transfusion was historically considered a firstline intervention for antiplateletassociated bleeding. However, the PATCH trial challenged this approach, demonstrating increased mortality and worse functional outcomes among patients receiving