Abstract W P65: Clevidipine Outperforms Other Agents in Emergent Acute Hypertension Treatment in Ischemic Stroke Pre-rt-PA
Hypothesis: Minimizing Acute Hypertension Treatment (AHT) time in rt-PA candidates is one means to reduce door to needle times. We have used nicardipine, labetalol and clevidipine at our institution for treatment of ischemic stroke patients in the ED. We assessed the hypothesis that if one agent could be identified that safely outperformed others, door to blood pressure control times could be improved in patients otherwise eligible for rt-PA.
Methods: We evaluated all ischemic stroke ED patients receiving rt-PA at our institution from 1/1/07 - 1/31/14; data from ischemic stroke patients requiring AHT prior to administration of rt-PA were analyzed by agent.
Results: Two hundred thirty two patients received rt-PA; 32 (14%) required AHT. Diagnoses: Unspecified Cerebral Occlusion, 21 (9%); Embolic
Ischemic Stroke, 8 (3%); Thrombotic Ischemic Stroke, 1 (<1%); Vertebral
Artery Occlusion Ischemic Stroke, 1 (<1%); Carotid Artery Occlusion Ischemic Stroke, 1 (<1%). Data were analyzed by agent. Five patients were excluded due to limited BP documentation; 12 patients received labetalol, 10 patients received clevidipine, and 2 patients received nicardipine. Three additional patients failed labetalol and were switched to clevidipine. Median time from drug initiation to BP goal (MTG) and median elapsed times from door to rt-PA administration (MET) were calculated. MTG and MET were: Labetalol: 43 minutes (range 5 to 83) and 97.5 minutes (range 57 to 127); Clevidipine: 16 minutes (range 6 to 24) and 54 minutes (range 50 to 120); Nicardipine:30.5 minutes (range 5 to 56) and 113 minutes (range 102 to 124). Clevidipine Rescued MTG: 11 minutes (range 10 to 30). AHT volume administered, median (range): Labetalol 15 ml (5-40); Nicardipine 30.4 ml (16-44.8); and Clevidipine 1.8 ml (0.7-8.6).
Conclusions: In conclusion we found of AHT drugs prescribed in this study population, clevidipine demonstrated the shortest median time-to-BP control, the shortest median door-to-rt-PA administration and the lowest administered volume. On the basis of these data, clevidipine is now first line AHT for rt-PA candidates at our institution. The study is ongoing.
Author Disclosures: S.S. Brehaut: Speakers' Bureau; Modest; The Medicines Company. Consultant/Advisory Board; Modest; The Medicines Company. A.M. Roche: Consultant/Advisory Board; Modest; The Medicines Company.
- © 2015 by American Heart Association, Inc.