Oral Glyburide for the Prevention of Cerebral Edema in Acute Ischemic Stroke.

OBJECTIVE: The purpose of this study was to describe the impact of enteral glyburide on cerebral edema formation and hypoglycemia when used in patients diagnosed with acute ischemic stroke (AIS).

METHODS: This study was a single-center, retrospective chart review that included all patients at least 18 years of age diagnosed with AIS who received at least one dose of enteral glyburide for the prevention of cerebral edema from January 1st, 2018 to March 31st, 2022. The primary outcome was to describe the percentage of patients requiring intervention for cerebral edema management following glyburide initiation, and the safety outcome was to describe the occurrence of hypoglycemia in this patient population.

RESULTS: The final evaluation included 44 patients, with 6 (14%) patients requiring intervention for cerebral edema after glyburide initiation. Average baseline NIHSS was 19. Overall, in-hospital mortality was 17 (36%), and hypoglycemia occurred in 7 (15%) patients. Twenty (45%) patients received a partial duration of enteral glyburide (1-4 doses) and 24 (55%) patients received a full duration of enteral glyburide (5-7 doses). There was a lower rate of intervention for cerebral edema (10% vs 17%) and hypoglycemia (5% vs 23%) in the partial duration versus the full duration group, respectively. In-hospital all-cause mortality rate was higher in the partial duration versus the full duration group (43% vs 31%).

CONCLUSIONS: Despite relatively low rates of intervention for cerebral edema, hypoglycemia was common, particularly in patients receiving 5-7 doses of enteral glyburide for the prevention of cerebral edema in patients with moderate-to-severe AIS.