Abstract WP331: Choice of Antihypertensive Agent Prior to Thrombolysis Has No Affect on Door-to-Needle Time: A Single Center Experience

Abstract

Introduction: Treatment of acute ischemic stroke with intravenous thrombolysis (IVT) should be as rapid as possible. A subset of patients with acute ischemic stroke present with blood pressures above that considered safe for thrombolytic administration, and antihypertensive therapy is necessary. Guideline statements are ambivalent regarding which antihypertensive agent should be used to obtain a satisfactory blood pressure (BP < 185/110 mmHg) prior to IVT. Hypothesis: DTN time will not differ amongst the antihypertensive agent groups. Methods: We reviewed data from consecutive patients at our institution treated with IVT from 01/2014 to 07/2018 and collected door-to-needle (DTN) time, antihypertensive agent (if used), and antihypertensive-to-needle (ATN) time. Patients were grouped by initial agent administered. An independent samples t-test was used to compare the labetalol and nicardipine group DTN and ATN times, as well as DTN times for patients receiving any antihypertensive agent with DTN times for those who did not. We performed a one-way ANOVA to compare DTN times across all groups (no agent, labetalol, nicardipine, hydralazine). Significance was defined as p < 0.05 for all tests. Results: Analysis included 205 patients: 149 receiving no antihypertensive, 42 receiving labetalol, 12 receiving nicardipine, and 2 receiving hydralazine. Those not administered an antihypertensive prior to IVT had shorter DTN times (53.05 min versus 61.96 min, p = 0.039). Although not statistically significant, there was a trend towards longer DTN (64.76 min versus 51.33 min, p = 0.205) and ATN times (18.02 min versus 10.58 min, p = 0.171) in the labetalol group. There was not a difference in DTN time across all groups (F(3,205) = 2.213, p = 0.088), although labetalol trended towards higher times than those not administered any agent on post-hoc Tukey HSD test (p = 0.071). Conclusions: At our institution, patients requiring antihypertensive treatment did experience slower DTN times. Choice of antihypertensive agent did not affect DTN times, however there was a trend towards slower times with labetalol. This study is limited by relatively small sample size. Pooling data from multiple institutions could provide a more robust assessment and inform clinical practice.