Sara Saldana, PharmD, BCCCP,
Health First Holmes Regional Medical Center
Melbourne
Disclosure information not submitted.
James Breslin, PharmD, BCPS
Clinical Pharmacy Specialist
Health First Holmes Regional Medical Center, United States
Disclosure information not submitted.
Jennifer Hanify, PharmD, BCCCP
Clinical Pharmacist
Duke University Hospital, United States
Disclosure information not submitted.
Theodore Heierman, PharmD
Clinical Pharmacy Specialist
Health First Holmes Regional Medical Center, United States
Disclosure information not submitted.
Kristina Larizadeh, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
Health First Holmes Regional Medical Center, Florida, United States
Disclosure information not submitted.
Michael Sanchez, PharmD, BCCCP
Pharmacy Residency Coordinator
Health First Holmes Regional Medical Center, Florida, United States
Disclosure information not submitted.
William Phipps, MD
Critical Care Specialist
Health First Holmes Regional Medical Center, United States
Disclosure information not submitted.
Title: Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Hemorrhagic Stroke
INTRODUCTION: Intracranial hemorrhage is associated with high mortality and morbidity. Lowering systolic blood pressure (SBP) with intravenous antihypertensives such as nicardipine or clevidipine may reduce the risk of hematoma expansion and rebleeding. Previous studies comparing nicardipine and clevidipine in stroke included ischemic stroke patients, which may confound the results with faster door-to-needle times. The purpose of this study was to compare clevidipine to nicardipine in time to goal SBP in hemorrhagic stroke.
Methods: This single-center retrospective observational cohort study evaluated adult hemorrhagic stroke patients who received clevidipine or nicardipine from January 1, 2015 to December 31, 2020. The primary outcome was time to goal SBP. Secondary outcomes included the need for additional antihypertensives, percent time at goal SBP, all-cause mortality, 30-day readmission, rebleeding, total volume of antihypertensive infusion, hematoma expansion, intensive care unit length of stay (LOS), hospital LOS, and medication cost. Safety outcomes included incidence of hypotension, severe hypotension, rebound hypertension, bradycardia, tachycardia, onset of atrial fibrillation, and acute kidney injury.
Results: Of 89 patients included in this study, 60 received nicardipine and 29 received clevidipine. There was no significant difference between nicardipine and clevidipine in median time to goal SBP (30 vs. 45 minutes; p=0.73); results were not affected by age, race, sex, stroke type, smoking history, hypertension, Glasgow Coma Score, or baseline SBP in the multiple linear regression. The nicardipine group had a higher total volume from infusion compared to clevidipine (1410 vs. 330 mL; p< 0.0001), but a significantly lower cost ($99.55 vs. $497.44; p< 0.0001). Compared to clevidipine, the nicardipine group had less rebound hypertension (40% vs. 75.86%; p=0.0017) and less bradycardia (23.33% vs. 44.83%; p=0.05). There were no significant differences in the other secondary or safety outcomes.
Conclusion: In hemorrhagic stroke patients, nicardipine appeared to have similar efficacy as clevidipine in SBP reduction with a more likely reduction of rebound hypertension, bradycardia, and drug cost. This retrospective study was underpowered and further prospective studies are warranted to confirm these results.