Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction:
Patients with acute ischemic stroke (AIS) often present with elevated blood pressure (greater than 185/110mmHg) which must be lowered prior to administering thrombolytics. The current AHA/ASA guideline for AIS does not recommend a preferential antihypertensive agent in this setting.
Research Question or Hypothesis:
Does the choice of initial antihypertensive agent affect time from antihypertensive to thrombolytic administration in patients presenting with BP > 185/110?
Study Design:
Single-center retrospective chart review of adults admitted to Methodist LeBonheur Healthcare in Memphis, TN between March 2022 and November 2023 who required antihypertensive medications prior to administration of thrombolytics.
Methods:
Cohorts were divided by initial type of antihypertensive used: intravenous push (IVP) or continuous infusion (CI). IVP agents included labetalol and hydralazine while nicardipine was the CI agent. Patients were excluded if they received both IVP and CI agents within 5 minutes of the initial agent.
Results:
One hundred patients were included: 44 in the IVP group and 56 in the CI group. The median baseline NIH stroke scale score was 6. The highest systolic blood pressure was higher in the CI group (193mmHg vs 207mmHg, p <0.001). The median antihypertensive-to-thrombolytic time was significantly shorter in the IVP group compared to the CI group (9.5 minutes vs 15 minutes, p= 0.005). Door-to-thrombolytic time was shorter in the IVP group also (57.5 minutes vs 67 minutes, p= 0.038). There were no statistically significant differences in use of rescue antihypertensives, bradycardia, hypotension, hypertension, functional outcomes at discharge, hemorrhagic transformation, or angioedema between the two groups.
Conclusion:
IVP antihypertensives may decrease the time from antihypertensive agent to thrombolytic administration in AIS patients who require blood pressure lowering to meet criteria for thrombolytics. Ease of administration and quick onset of action of IVP agents may allow for faster antihypertensive-to-thrombolytic times without increasing rates of adverse effects. Functional outcomes were not impacted with this intervention.
Presenting Author
Lisa Hayes PharmD, BCCCP, BCEMPMethodist University Hospital
Authors
Dennis Marjoncu PharmD BCOP
Methodist University Hospital
Ana Negrete PharmD, BCPS, BCEMP
Methodist University Hospital
Michael Samarin PharmD, BCPS, BCCCP
Methodist Le Bonheur Healthcare - University Hospital
Katelyn Williams PharmD
Methodist University Hospital