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Comparative effects of angiotensin receptor blockade and ACE inhibition on the fibrinolytic and inflammatory responses to cardiopulmonary bypass.

Billings FT, Balaguer JM, C Y, Wright P, Petracek MR, Byrne JG, Brown NJ, Pretorius M - Clin. Pharmacol. Ther. (2012)

Bottom Line: ACE inhibition increased intraoperative bradykinin and tissue-type plasminogen activator (t-PA ) concentrations as compared to AR B.Both ACE inhibition and AR B decreased the need for plasma transfusion relative to placebo, but only ACE inhibition decreased the duration of hospital stay.ACE inhibitors and ARBs may be safely continued until the day of surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Vanderbilt University Medical School, Nashville, Tennessee, USA.

ABSTRACT
The effects of angiotensin-converting enzyme (ACE) inhibition and angiotensin II type 1 receptor blockade (ARB) on fibrinolysis and inflammation after cardiopulmonary bypass (CPB) are uncertain. This study tested the hypothesis that ACE inhibition enhances fibrinolysis and inflammation to a greater extent than ARB in patients undergoing CPB. One week to 5 days before surgery, patients were randomized to ramipril 5 mg/day, candesartan 16 mg/day, or placebo. ACE inhibition increased intraoperative bradykinin and tissue-type plasminogen activator (t-PA ) concentrations as compared to AR B. Both ACE inhibition and AR B decreased the need for plasma transfusion relative to placebo, but only ACE inhibition decreased the duration of hospital stay. Neither ACE inhibition nor AR B significantly affected concentrations of plasminogen activator inhibitor-1 (PAI -1), interleukin (IL )-6, IL -8, or IL -10. ACE inhibition enhanced intraoperative fibrinolysis without increasing the likelihood of red-cell transfusion. By contrast, neither ACE inhibition nor ARB affected the inflammatory response. ACE inhibitors and ARBs may be safely continued until the day of surgery.

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Related in: MedlinePlus

Study enrollment.
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Related In: Results  -  Collection


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Figure 1: Study enrollment.

Mentions: One hundred and eleven patients were consented to participate (Figure 1). Two patients did not meet inclusion/exclusion criteria. Seventeen subjects withdrew prior to randomization, and surgery was cancelled in five subjects. Eighty-seven subjects were randomized, and thirteen of those were excluded for the following reasons. Four subjects changed their mind and withdrew after randomization but prior to taking study medication, three subjects did not receive study drug in time, one subject's surgery date was changed, one subject's surgery was cancelled, two subjects experienced low blood pressure and weakness and stopped study drug, one subject's creatinine rose >1.6 mg/dl prior to surgery, and one subject had surgery without CPB. Seventy-four subjects completed the study protocol and were included in the final analysis.


Comparative effects of angiotensin receptor blockade and ACE inhibition on the fibrinolytic and inflammatory responses to cardiopulmonary bypass.

Billings FT, Balaguer JM, C Y, Wright P, Petracek MR, Byrne JG, Brown NJ, Pretorius M - Clin. Pharmacol. Ther. (2012)

Study enrollment.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3822756&req=5

Figure 1: Study enrollment.
Mentions: One hundred and eleven patients were consented to participate (Figure 1). Two patients did not meet inclusion/exclusion criteria. Seventeen subjects withdrew prior to randomization, and surgery was cancelled in five subjects. Eighty-seven subjects were randomized, and thirteen of those were excluded for the following reasons. Four subjects changed their mind and withdrew after randomization but prior to taking study medication, three subjects did not receive study drug in time, one subject's surgery date was changed, one subject's surgery was cancelled, two subjects experienced low blood pressure and weakness and stopped study drug, one subject's creatinine rose >1.6 mg/dl prior to surgery, and one subject had surgery without CPB. Seventy-four subjects completed the study protocol and were included in the final analysis.

Bottom Line: ACE inhibition increased intraoperative bradykinin and tissue-type plasminogen activator (t-PA ) concentrations as compared to AR B.Both ACE inhibition and AR B decreased the need for plasma transfusion relative to placebo, but only ACE inhibition decreased the duration of hospital stay.ACE inhibitors and ARBs may be safely continued until the day of surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Vanderbilt University Medical School, Nashville, Tennessee, USA.

ABSTRACT
The effects of angiotensin-converting enzyme (ACE) inhibition and angiotensin II type 1 receptor blockade (ARB) on fibrinolysis and inflammation after cardiopulmonary bypass (CPB) are uncertain. This study tested the hypothesis that ACE inhibition enhances fibrinolysis and inflammation to a greater extent than ARB in patients undergoing CPB. One week to 5 days before surgery, patients were randomized to ramipril 5 mg/day, candesartan 16 mg/day, or placebo. ACE inhibition increased intraoperative bradykinin and tissue-type plasminogen activator (t-PA ) concentrations as compared to AR B. Both ACE inhibition and AR B decreased the need for plasma transfusion relative to placebo, but only ACE inhibition decreased the duration of hospital stay. Neither ACE inhibition nor AR B significantly affected concentrations of plasminogen activator inhibitor-1 (PAI -1), interleukin (IL )-6, IL -8, or IL -10. ACE inhibition enhanced intraoperative fibrinolysis without increasing the likelihood of red-cell transfusion. By contrast, neither ACE inhibition nor ARB affected the inflammatory response. ACE inhibitors and ARBs may be safely continued until the day of surgery.

Show MeSH
Related in: MedlinePlus