Utilization of Stroke Kit Antihypertensives Prior to Thrombolysis in Acute Ischemic Stroke: A Single-Center Retrospective Audit

Abstract

Background: Current hospital guideline recommends intravenous (IV) hydralazine to reduce blood pressure (BP) to < 185/110 mm Hg in acute ischemic stroke (AIS) patients receiving thrombolysis, with verapamil and metoprolol as alternatives. Emergency department (ED) stroke kits (SK) contain alteplase and these IV antihypertensives. Tenecteplase is a second-line thrombolytic kept separately along with IV labetalol in the resuscitation medication room (RMR). However, other hospitals in Victoria recommend hydralazine, labetalol, and nicardipine for AIS. This study was carried out to determine the frequency of antihypertensives used from the ED SK versus the RMR at a tertiary hospital and to assess the time to reach target BP for thrombolysis.

Methods: A retrospective audit was conducted between 2021 and 2024. The electronic medical records were utilized to identify eligible participants. Inclusion criteria included adult ED hypertensive patients administered either IV hydralazine or labetalol who presented with AIS and indicated for thrombolysis. Patients subsequently administered IV metoprolol or verapamil following hydralazine or labetalol administration were also included.

Results: Out of 349 screened patients, six met the inclusion criteria. Four were treated with alteplase and two with tenecteplase for thrombolysis. One patient (25%) received hydralazine from the SK, the remainder from the RMR. The median time to reach target BP after hydralazine administration was 4.5 min (range: 2–18). No patients received labetalol, metoprolol or verapamil for AIS pre-thrombolysis.

Conclusions: Antihypertensives from the SK were infrequently used, warranting a review of SK contents. Due to a small sample size, the optimal antihypertensive for thrombolysis in AIS could not be determined, suggesting that further research is required.