(977) Medical Management of Type B Aortic Dissections: Transition From Intravenous to Oral Therapy

Introduction: Aortic dissection is a severe hypertensive emergency that carries significant consequences if not managed appropriately. Uncomplicated Type B aortic dissections (TBAD) can be managed with medications alone to appropriately control blood pressure and heart rate. National guidelines for aortic dissection management focus primarily on acute management with intravenous (IV) therapies. As a result, there is little guidance on how and when providers should integrate oral medications to achieve hemodynamic targets and facilitate de-escalation of care. The timely transition from intravenous to oral therapy has demonstrated improved convenience, comfort, and cost in select patient populations; however, the optimum time to transition to oral therapy is not yet established among patients with TBAD. This study aims to characterize how the University of Maryland Medical Center (UMMC) transitions from IV to oral anti-hypertensive agents in patients with TBAD.

Methods: This single-center retrospective cohort study evaluates the prescribing practices at UMMC related to the management of TBAD. The primary outcome assessed the time to transition patients from intravenous to oral anti-hypertensive therapies with secondary outcomes investigating the duration of intensive care unit (ICU) and hospital stays, barriers to oral transitions, and incidence of end-organ hypoperfusion. Patients were divided into early- and late-transition groups if the transition occurred before or after the median time for the entire cohort (3.7 days).

Results: Among fifty-one enrolled patients, those that achieved an early transition to oral therapy had shorter ICU and hospital lengths of stay and faster time to arterial catheter removal, without evidence of significant end-organ hypoperfusion. While there were several barriers to oral therapy identified, the patients that experienced a late transition more frequently had delays in scheduling surgical interventions.

Conclusions: While it is possible that patients who had a late transition to oral therapy may have had more complex dissections or refractory hypertension, these results suggest that early integration of oral therapies decreases the length of stay without putting patients at additional risk.