Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Patients With Stroke

Allison, Teresa A.; Bowman, Stephanie; Gulbis, Brian; Hartman, Heather; Schepcoff, Sara; Lee, Ki-Won

doi:10.1177/0885066617724340

Cited by 16 publications

(21 citation statements)

References 21 publications

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“…Given the considerable difference in the management of ischemic and hemorrhagic stroke, separate evaluation appeared warranted. This study found no significant difference in time to goal SBP between nicardipine and clevidipine, which supports previous findings in the combined patients with ischemic and hemorrhagic stroke [11,14,15]. Additionally, percentage of time at goal was similar between groups.…”

Section: Discussionsupporting

confidence: 90%

“…AHA/ASA guidelines have not specified a preferred titratable antihypertensive agent. There have been three retrospective direct comparisons of nicardipine with clevidipine in patients with ischemic and hemorrhagic stroke [11,14,15]. There was no significant difference in time to goal SBP between nicardipine and clevidipine in all three studies.…”

Section: Introductionmentioning

confidence: 99%

“…There was no significant difference in time to goal SBP between nicardipine and clevidipine in all three studies. A limitation of these studies was the inclusion of patients with acute ischemic stroke, which potentially confounded results because of faster door-to-needle times [11,14,15]. There is limited evidence in comparing nicardipine with clevidipine solely in patients with hemorrhagic stroke.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Hemorrhagic Stroke

Saldana

Breslin²,

Hanify

et al. 2021

Neurocrit Care

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Background: Intracranial hemorrhage is associated with high mortality and morbidity. Lowering systolic blood pressure (SBP) with an intravenous antihypertensive, such as nicardipine or clevidipine, may reduce the risk of hematoma expansion and rebleeding. Previous studies comparing nicardipine and clevidipine in patients with stroke found no significant difference in blood pressure management. The inclusion of patients with ischemic stroke limited those studies because of convoluted results related to faster door-to-needle times. The purpose of this study was to compare clevidipine with nicardipine in time to goal SBP in hemorrhagic stroke.Methods: This single-center retrospective observational cohort study evaluated adult hemorrhagic patients with stroke who received clevidipine or nicardipine from January 1, 2015, to December 31, 2020. Patients were excluded if they had trauma-related hemorrhage, received concurrent continuous intravenous antihypertensives, received the study drug for less than 1-h duration, had a less than 24-h washout period between agents, required any dialysis, were pregnant, or were incarcerated. The primary outcome was time to goal SBP. Secondary outcomes included need for additional antihypertensives, percentage of 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 cost of infusion. Safety outcomes included 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 time to goal SBP in the unmatched cohort (30 vs. 45 min; p = 0.73) or the propensity-score-matched cohort (30 vs. 45 min; p = 0.47). Results were not affected by potential confounders in the multiple linear regression. The nicardipine group had a higher total volume from infusion compared with the clevidipine group (1410 vs. 330 mL; p < 0.0001) but significantly lower cost ($99.6 vs. $497.4; p < 0.0001). There were no significant differences in need for additional antihypertensives, percentage of time at goal SBP, all-cause mortality, 30-day readmission, rebleeding, hematoma expansion, intensive care unit LOS, and hospital LOS. Compared with the clevidipine group, the nicardipine group had less rebound hypertension (40% vs. 75.9%; p = 0.0017) and less bradycardia (23.3% vs. 44.8%; p = 0.05). There were no significant differences in hypotension, severe hypotension, tachycardia, and acute kidney injury.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Hemorrhagic Stroke

Saldana

Breslin²,

Hanify

et al. 2021

Neurocrit Care

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“…11 A retrospective cohort study involving 210 patients in the emergency department with ischemic or hemorrhagic strokes established that clevidipine (50 [SD, 83] minutes and nicardipine (74 [SD, 103] minutes) both achieved the systolic BP goal (P ¼ .101). 12 Therefore, the recommendation is that NPs can use nicardipine or sodium nitroprusside to reduce systolic, diastolic, and mean arterial pressures (MAPs) in an HC.…”

Section: The Mnemonicmentioning

confidence: 99%

The Unprecedented COVID-19 Crisis

Thomas¹

2020

The Journal for Nurse Practitioners

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Hypertensive crises (HCs) are common occurrences and can result in immediate or delayed organ damage. Given the complex pathophysiological process associated with HCs, selecting the appropriate treatment can be a challenge. The goal of this report is to provide nurse practitioners with an up-to-date and evidencebased mnemonic tool to help effectively manage HCs. Using an alphabetized mnemonic provides nurse practitioners with quick recall into the treatment options of HCs. The ABCD mnemonic will cover antihypertensive drug classes such as Arterial/venous dilators, Beta (b)-blockers, Calcium channel blockers, and Diuretics.

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“…53 For patients who are critically ill or are to receive tPA or other interventions, clevidipine and nicardipine are the agents of choice for rapidly lowering blood pressure. 32,54 Rapid fluctuations in blood pressure within the first 180 minutes of hospital stay were associated with increased mortality rate within 90 days for acute ischemic stroke patients. As compared to patients with smaller variations in blood pressure, patients who died within 90 days were found to have larger changes in their diastolic blood pressures within the first 180 minutes.…”

Section: Blood Pressure Considerationsmentioning

confidence: 99%

Emergency management of stroke in the era of mechanical thrombectomy

Brandler

Baksh

2019

Clin Exp Emerg Med

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Emergency management of stroke has been directed at the delivery of recombinant tissue plasminogen activator (tPA) in a timely fashion. Because of the many limitations attached to the delivery of tPA and the perceived benefits accrued to tPA, its use has been limited. Mechanical thrombectomy, a far superior therapy for the largest and most disabling strokes, large vessel occlusions (LVOs), has changed the way acute strokes are managed. Aside from the rush to deliver tPA, there is now a need to identify LVO and refer those patients with LVO to physicians and facilities capable of delivering urgent thrombectomy. Other parts of emergency department management of stroke are directed at identifying and mitigating risk factors for future strokes and at preventing further damage from occurring. We review here the most recent literature supporting these advances in stroke care and present a framework for understanding the role that emergency physicians play in acute stroke care.

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Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Patients With Stroke

Abstract: There was no difference in the mean time from initiation of the infusion to the SBP goal between agents or in the secondary outcomes. Due to the lack of differences observed, each agent should be considered based on the patient care needs of the institution.

Cited by 16 publications

References 21 publications

Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Hemorrhagic Stroke

Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Hemorrhagic Stroke

The Unprecedented COVID-19 Crisis

Emergency management of stroke in the era of mechanical thrombectomy

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