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A Multicenter Comparison of Outcomes Associated with Intravenous Nitroprusside and Nicardipine Treatment Among Patients with Intracerebral Hemorrhage

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Abstract

Introduction

No clinical data exist to compare outcomes between patients with intracerebral hemorrhage (ICH) treated with different intravenous antihypertensive agents. This study was performed to compare outcomes among patients with ICH who were treated with intravenous infusion of different antihypertensive medications during the first 24 hours after admission.

Methods

We analyzed one-year data (2005–2006) from the Premier database which is a nationally representative hospital discharge database containing data pertaining to admissions in the United States. We compared discharge outcomes, length of stay, and cost of hospitalization between groups of patients who were treated using either intravenous nicardipine or nitroprusside infusion. Chi-square and ANOVA were used for univariate analysis. Logistic and linear regression analyses were performed to adjust for baseline risk of mortality between the two groups.

Results

A total of 12,767 admissions with primary diagnosis of ICH were identified. Nicardipine was administered in 926 patients (7.3%) and nitroprusside was administered in 530 (4.3%) patients. There was no difference in baseline disease severity or risk of mortality among patients who were administered nicardipine or nitroprusside. After adjustment for baseline risk of mortality, the risk of in-hospital mortality (odds ratio [OR] 1.7, 95% confidence interval [95% CI] 1.3–2.2) was higher among patients treated with nitroprusside compared with nicardipine. The risk of in-hospital mortality was also higher after adjustment for baseline risk of mortality and hospital characteristics in patients treated with nitroprusside (OR 1.6, 95% CI 1.2–2.1). After exclusion of patients who died during hospitalization, there was no difference in length of stay and total hospital cost in the multivariate analysis.

Conclusion

Use of nicardipine compared with nitroprusside infusion during the first 24 h after ICH may be associated with reduced risk of in-hospital mortality without any increase in the hospitalization cost or length of stay.

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Acknowledgments

The AMUST study was in part supported by EKR pharmaceuticals. Dr. Suri is supported by National Institute's of Health (NIH) grant 5K12-RR023247-03. Dr. Qureshi is supported in part by NIH's grant RO-1-NS44976-01A2 and the American Heart associations established Investigators Award 0840053N.

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Authors and Affiliations

  1. Zeenat Qureshi Stroke Research Center, Minnesota Stroke Initiative, Departments of Neurology and Neurosurgery, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, 55455, MN, USA

    M. Fareed K. Suri, Gabriela Vazquez, Mustapha A. Ezzeddine & Adnan I. Qureshi

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  1. M. Fareed K. Suri
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  2. Gabriela Vazquez
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  3. Mustapha A. Ezzeddine
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  4. Adnan I. Qureshi
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Correspondence to M. Fareed K. Suri.

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Suri, M.F.K., Vazquez, G., Ezzeddine, M.A. et al. A Multicenter Comparison of Outcomes Associated with Intravenous Nitroprusside and Nicardipine Treatment Among Patients with Intracerebral Hemorrhage. Neurocrit Care 11, 50–55 (2009). https://doi.org/10.1007/s12028-009-9192-1

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  • DOI: https://doi.org/10.1007/s12028-009-9192-1

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