NCT06402968招募中不适用
Clevidipine for the Antihypertensive Treatment of Acute Intracerebral Hemorrhage
Zeenat Qureshi Stroke Institute20 个研究点 分布在 1 个国家目标入组 1,018 人开始时间: 2024年6月1日最近更新:
适应症
干预措施
相关药物
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 1,018
- 试验地点
- 20
- 主要终点
- Blood Pressure Monitoring
研究概览
简要总结
The aim is to compare the rate of hypertensive subjects with ICH who reach SBP target with stability within 60 minutes of enrollment, among patients treated with IV clevidipine with those treated with alternate IV antihypertensive regimen.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 100 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18 years or older and less than 100 years.
- •Onset of new neurological deficits within 12 hours at the time of enrollment and IV clevidipine or alternate IV antihypertensive regimen can be initiated within 12 hours of symptom onset.
- •Clinical signs consistent with the diagnosis of stroke, including impairment of language, motor function, cognition, and/or gaze, vision, or neglect.
- •Initial National Institutes of Health Stroke Scale (NIHSS) score of 1 or greater.
- •Total GCS score (aggregate of verbal, eye, and motor response scores) of 5 or greater at enrollment
- •Computed Tomography (CT) scan of the brain demonstrates intraparenchymal hematoma with manual hematoma volume measurement >5 cc (excluding microhemorrhages)
- •Admission SBP greater than and equal to 150 mmHg but less than 220 mmHg on two repeat measurements at least 5 minutes apart, but no more than 10 minutes apart. The reason for exclusion of ICH patients with initial SBP ≥220 mm Hg is based on a post hoc analysis of ATACH-2, which found that patients with initial SBP ≥220 mm Hg (22.8% of the cohort) reported higher rates of neurological deterioration at 24 hours and renal adverse events until day 7 or discharge in patients treated with intensive SBP reduction compared with standard SBP lowering, without any benefit in reducing hematoma expansion at 24 hours or death or severe disability at 90 days.
- •Signed and dated informed consent by subject, legally authorized representative, or surrogate before index hospital discharge for data collection and agreement to participate in 90- and 180-day follow-up visits.
- •Patients with anticoagulant-related ICH are eligible as long as anticoagulant reversal is concurrently undertaken consistent with AHA/ASA guidelines.
- •Patients who will undergo surgical evacuation consistent with AHA/ASA guidelines or local institutional guidelines are eligible unless surgical evacuation is being performed within 6 hours of initiation of IV clevidipine or alternate IV antihypertensive medication regimen. Ultra-early surgery will necessitate use of anesthetic agents which will confound the effect of IV clevidipine or alternate IV antihypertensive medication regimen. Ultra-early surgery/intervention was not used in the minimally invasive catheter evacuation followed by thrombolysis (MISTIE)/ Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR) trials, which required ICH patients to undergo a repeat CT scan after 6 hours to document absence of any hematoma expansion (with ≤5 mL hematoma growth) compared to a previous CT scan prior to any surgical intervention.
- •Patients requiring external ventricular drainage consistent with AHA/ASA guidelines or local institutional guidelines are eligible.
排除标准
- •Time of symptom onset cannot be reliably assessed.
- •Previously known neoplasms, arteriovenous malformation (AVM), or aneurysms.
- •Intracerebral hematoma considered to be related to trauma.
- •ICH located in infratentorial regions such as pons or midbrain (cerebellar ICH is not an exclusion criteria).
- •Subject considered a candidate for immediate surgical intervention by the neurosurgery service.
- •Pregnancy, parturition within previous 30 days, or active lactation.
- •Any history of bleeding diathesis or coagulopathy except anticoagulant related ICH.
- •Platelet count of less than 50,000/mm
- •Known sensitivity to nicardipine or clevidipine.
- •Patient's living will precludes aggressive ICU management.
- •Patients with allergies to soybeans, soy products, eggs, or egg products.
- •Defective lipid metabolism such as pathologic hyperlipemia, lipoid nephrosis, or acute pancreatitis if it is accompanied by hyperlipidemia.
- •Patients with severe aortic stenosis.
研究组 & 干预措施
designated non-clevidipine hospitals
干预措施: Alternate IV Antihypertensive Regimen (Drug)
designated clevidipine hospitals
干预措施: Clevidipine Injection (Drug)
结局指标
主要结局
Blood Pressure Monitoring
时间窗: 15 minutes
To compare the rate of hypertensive subjects with ICH who reach SBP target with stability within 60 minutes of enrollment, among patients treated with IV clevidipine with those treated with alternate IV antihypertensive regimen. SBP target with stability is defined as achieving a SBP of less than 150 mm Hg and greater than 130 mm Hg with two subsequent consecutive recordings at least 15 minutes apart that show SBP of less than 150 mm Hg and greater than 130 mm Hg.
次要结局
未报告次要终点
研究者
研究点 (20)
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