Is continuous infusion labetalol haemodynamically safe for type B aortic dissections?

Treatment with high-dose continuous intravenous labetalol (HD-CIVL) results in a nonstatistically significant higher incidence of haemodynamic instability compared to an esmolol combination (EC) regimen in patients with type B aortic dissections (TBADs), results of a study have shown.

The authors conducted this single-centre, retrospective analysis in patients with TBAD who received HD-CIVL or EC therapies. Those who received either regimen for a minimum of 2 hours, during which a minimum of four blood pressure readings were recorded, were included in the analysis. The incidence of haemodynamic instability with the use of HD-CIVL vs EC therapies was the primary endpoint.

Twenty patients receiving HD-CIVL and 22 receiving EC therapy were included in the analysis. Ten patients (50 percent) in the HD-CIVL arm and seven (32 percent) in the EC therapy arm met the clinical definition of haemodynamic instability (p=0.23). Hypotension was the cause of haemodynamic instability in these patients and bradycardia in one.

Additionally, more than half of the patients in both groups discontinued treatment (p=0.06) and were given bolus fluids (p=0.27). Only one patient on HD-CIVL required vasopressor administration and none in the EC group (p=0.48).

Further research is warranted in this patient population, according to the authors.

“Medical management for TBADs require aggressive blood pressure and heart rate control to minimize further dissection extension and to restore perfusion to vital organs,” the authors said. “Current guidelines recommend beta-blockers as first-line therapy.”