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Clevidipine versus sodium nitroprusside in acute aortic dissection: A retrospective chart review
Alexandru Ulici1, Jon Jancik1, Timothy S Lam1
1Department of Pharmacy, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, United States.
Insights
Clevidipine and sodium nitroprusside (SNP) showed similar efficacy in managing blood pressure for aortic dissection patients. Clevidipine offers a significantly less costly alternative to SNP for this critical condition.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Critical Care
Background:
- Intravenous vasodilators are frequently used with beta-blockers to achieve blood pressure goals in aortic dissection.
- Clevidipine's efficacy has been established in hypertensive emergencies and cardiac surgery, but not specifically in aortic dissection management.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of clevidipine versus sodium nitroprusside (SNP) as adjunct therapies to esmolol for blood pressure management in patients with aortic dissection.
Main Methods:
- A single-center retrospective chart review of patients diagnosed with aortic dissection.
- Primary outcome: time to reach patient-specific systolic blood pressure (SBPPT) goals after esmolol initiation.
- Efficacy assessed by area under the curve (AUCSBPe) of blood pressure excursions outside of goal; cost analysis based on average wholesale price.
Main Results:
- No significant difference in median time to reach SBPPT goals between clevidipine and SNP groups (1.68 vs 1.03 hours).
- Similar median AUCSBPe values, indicating comparable efficacy in maintaining blood pressure control.
- Clevidipine was significantly less costly ($1223.28/day) compared to SNP ($7674.24/day).
Conclusions:
- Clevidipine demonstrates similar efficacy to SNP as an adjunct to esmolol for blood pressure management in acute aortic dissection.
- Clevidipine presents a cost-effective and reasonable alternative to SNP in this clinical setting.
- Further research is warranted to confirm these findings.
Aim:
Intravenous vasodilators are often added to beta-blocking agents to reach blood pressure (BP) goals in aortic dissection. Control of BP using clevidipine has been described in hypertensive emergencies and cardiac surgery but not in aortic dissection. The aim of this study was to compare clevidipine versus sodium nitroprusside (SNP) as adjunct agents to esmolol for BP management in aortic dissection.
Methods:
A single-center retrospective chart review evaluated patients diagnosed with aortic dissection. The primary outcome measure was time to reach patient specific systolic blood pressure (SBPPT) goals after initiation of esmolol infusion. Efficacy of clevidipine and SNP was assessed using area under the curve analysis of positive and negative excursions outside of SBPPT goals (AUCSBPe). Cost data was calculated using average wholesale price in U.S. dollars.
Results:
Fourteen patients were included in final analyses. Median systolic BP immediately prior to initiation of esmolol was 162mm Hg vs 161mm Hg for clevidipine and SNP groups, respectively (p=0.99). Median time to reach SBPPT goal was similar between clevidipine and SNP (1.68 versus 1.03h [p=0.99]). Median AUCSBPe was similar for clevidipine and SNP (206.9 versus 538.9 mm Hg∗min∗hr-1 [p=0.11]). Cost was significantly reduced using clevidipine versus SNP ($1223.28/day versus $7674.24/day [p<0.001]).
Conclusions:
Clevidipine administration during initial medical management of aortic dissection showed similar efficacy compared to SNP when used as adjunct therapy to esmolol. These data suggest clevidipine is a less costly, reasonable alternative to SNP in acute aortic dissection as adjunct therapy to esmolol. Further studies are needed to validate these results.
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