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Original Paper

Clevidipine Rapidly and Safely Reduces Blood Pressure in Acute Intracerebral Hemorrhage: The ACCELERATE Trial

Graffagnino C.a · Bergese S.b · Love J.c · Schneider D.i · Lazaridis C.d · LaPointe M.e · Lee K.f · Lynch G.g · Hu M.h · Williams G.C.h

Author affiliations

aDuke University Medical Center, Durham, N.C., bOhio State University, Columbus, Ohio, cMoses H. Cone Health System, Greensboro, N.C., dMedical University of South Carolina, and eSouth Carolina College of Pharmacy, Charleston, S.C., fColumbia University Medical Center, New York, N.Y., gCleveland Clinic Hospitals, Cleveland, Ohio, and hThe Medicines Company, Parsippany, N.J., USA; iUniversity of Leipzig, Leipzig, Germany

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Cerebrovasc Dis 2013;36:173-180

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: August 20, 2012
Accepted: March 25, 2013
Published online: October 12, 2013
Issue release date: October 2013

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Background: Intracerebral hemorrhage (ICH) causes 10-15% of primary strokes, with mortality related to hematoma volume. Blood pressure (BP) reduction may attenuate hematoma expansion. ACCELERATE (the Evaluation of Patients with Acute Hypertension and Intracerebral Hemorrhage with Intravenous Clevidipine Treatment) is a pilot study representing the first evaluation of safety and efficacy of intravenous clevidipine for the rapid treatment of hypertension in ICH patients. Methods: ICH patients with a systolic BP (SBP) >160 mm Hg who present within 6 h (n = 27) or 12 h (n = 10) of symptoms were prospectively enrolled, treated with open-label clevidipine until SBP ≤160 mm Hg was achieved and then titrated to keep target SBP between 140-160 mm Hg. Results: A total of 35 patients with baseline median Glasgow Coma Scale score of 12, median NIH Stroke Scale score of 14, mean SBP of 186 mm Hg and a mean time from onset of symptoms of 5.5 h received clevidipine. Median time to achieve SBP target range was 5.5 min. All patients achieved target SBP within 30 min; 96.9% achieved target SBP with clevidipine monotherapy. CT scans showed minimal hematoma volume change for the overall population (median change 0.01 ml, -2.9%). Mild/moderate hypotension was reported in 3 patients and resolved with dose reduction or drug discontinuation. Conclusion: Clevidipine monotherapy was effective and safe for rapid BP reduction in this cohort of critically ill ICH patients. Overall, patients showed minimal hematoma expansion with BP reduction, suggesting that rapid BP control with clevidipine may have a beneficial impact on hematoma expansion and warrants further investigation.

© 2013 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: August 20, 2012
Accepted: March 25, 2013
Published online: October 12, 2013
Issue release date: October 2013

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


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