Safety and Efficacy Study of Clevidipine to Control Hypertension in Patients Admitted With Aneurysmal Subarachnoid Hemorrhage
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension), Neurology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Neurology |
| Healthy: | No |
| Age Range: | 18 - 80 |
| Updated: | 4/2/2016 |
| Start Date: | September 2009 |
| End Date: | June 2010 |
| Contact: | Panayiotis N Varelas, MD PhD |
| Email: | pvarela1@hfhs.org |
| Phone: | 313-916-0596 |
Clevidipine in Aneurysmal Subarachnoid Hemorrhage, A Pilot Study
This study is designed to assess how rapidly and how safely Clevidipine can be used to
control high Blood Pressure in patients with subarachnoid hemorrhage which is a type of
brain bleed that happens because of a weak balloon like structure in one of the brain
vessels. Control of blood pressure is of high value in preventing this balloon that ruptured
and bled from rebleeding. The ultimate cure would be to shut down the aneurysm by a surgical
procedure. Clevidipine is a drug that can lower blood pressure and it is given through the
vein as a continuous infusion. It is a very short acting drug which is important in
controlling labile blood pressure condition with rapid changes between up and down. This
trial will test for its rapid actions and check for any side effects and possibly any other
potential benefit.
control high Blood Pressure in patients with subarachnoid hemorrhage which is a type of
brain bleed that happens because of a weak balloon like structure in one of the brain
vessels. Control of blood pressure is of high value in preventing this balloon that ruptured
and bled from rebleeding. The ultimate cure would be to shut down the aneurysm by a surgical
procedure. Clevidipine is a drug that can lower blood pressure and it is given through the
vein as a continuous infusion. It is a very short acting drug which is important in
controlling labile blood pressure condition with rapid changes between up and down. This
trial will test for its rapid actions and check for any side effects and possibly any other
potential benefit.
This is a single center, single-arm, non-blinded dose titration efficacy and safety trial
evaluating the ability of clevidipine, a vascular-selective L-type calcium channel
antagonist, to rapidly control acute hypertension in patients with aneurysmal subarachnoid
hemorrhage. At screening a clinical and neurological examination will be carried out. For
the purposes of this study, acute hypertension will be defined as a range of SBP to be
controlled within immediately prior to initiation of study drug. Approximately 20 patients
with acute A SAH will be enrolled. Infusion of study drug will be initiated as soon ass the
patient arrives in the ER and diagnosis is made and consent is obtained. All eligible
patients will be enrolled to receive clevidipine in an open label manner.
Clevidipine will be infused at an initial rate of 2.0 mg/h for the first 90 seconds.
Thereafter, titration to higher infusion rates can be attempted as needed q90 seconds to
obtain the target SBP range.
Titration to effect is to proceed by doubling the dose every 90 seconds, up to a maximum of
32.0 mg/h, until the desired effect (SBP within the target range) is attained. Clevidipine
infusion may continue for up to a maximum of 48 hours. Blood pressure and ICP recording will
be recorded q 5 minutes. Assessment of safety will be performed throughout the treatment
period and until 6 hours after termination of study drug.
evaluating the ability of clevidipine, a vascular-selective L-type calcium channel
antagonist, to rapidly control acute hypertension in patients with aneurysmal subarachnoid
hemorrhage. At screening a clinical and neurological examination will be carried out. For
the purposes of this study, acute hypertension will be defined as a range of SBP to be
controlled within immediately prior to initiation of study drug. Approximately 20 patients
with acute A SAH will be enrolled. Infusion of study drug will be initiated as soon ass the
patient arrives in the ER and diagnosis is made and consent is obtained. All eligible
patients will be enrolled to receive clevidipine in an open label manner.
Clevidipine will be infused at an initial rate of 2.0 mg/h for the first 90 seconds.
Thereafter, titration to higher infusion rates can be attempted as needed q90 seconds to
obtain the target SBP range.
Titration to effect is to proceed by doubling the dose every 90 seconds, up to a maximum of
32.0 mg/h, until the desired effect (SBP within the target range) is attained. Clevidipine
infusion may continue for up to a maximum of 48 hours. Blood pressure and ICP recording will
be recorded q 5 minutes. Assessment of safety will be performed throughout the treatment
period and until 6 hours after termination of study drug.
Inclusion Criteria:
1. Diagnosis of SAH
2. Presence of unsecured aneurysm
3. Patient age between 18 and 80 years
4. Hunt and Hess grade <5 (non-sedated-paralyzed pt)
5. Glasgow Coma scale >4 (non-sedated-paralyzed pt)
6. BP above the pre-specified upper limit set by MD
7. Patient has not received pressors or inotropes
8. Patient has not received IV anti-hypertensives for more than 5 minutes (sodium
nitroprusside infusion should be stopped as clevidipine is started
9. Patient has given informed consent
Exclusion Criteria:
1. Patient is <18 or >80 years of age
2. Patient has Traumatic SAH
3. Patient has Perimesencephalic SAH
4. Hunt and Hess grade 5 (deeply comatose/ brain dead)
5. Glasgow Coma scale 3 or 4 (deeply comatose/brain dead)
6. Patient on pressors or anti-hypertensives for more than 5 minutes
7. SBP < 90 mm Hg
8. Heart rate >110
9. Patient with Left BBB
10. Patient with a permanent ventricular pacemaker
11. Known allergy to dihydropyridines or clevidipine
12. Known allergy to soy products, beans, eggs or egg products22. Patients with defective
lipid metabolism or pathologic hyperlipidemia or lipid nephrosis
13. Acute pancreatitis, accompanied by hyperlipidemia
14. Severe aortic stenosis
15. Pregnancy
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