High frequency of acute adverse cardiovascular events after lung transplantation in patients with pulmonary arterial hypertension receiving preoperative long-term intravenous prostacyclin

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Abstract

Adverse cardiovascular events after lung transplantation (LT) increase the mortality in patients with pulmonary arterial hypertension (PAH). Long-term intravenous prostacyclin is the usual treatment in severe patients with PAH, but it may increase the risk of hemorrhage due to its antiplatelet aggregation effect or thrombocytopenia. We investigated the impact of length of intravenous prostacyclin therapy on acute adverse cardiovascular events including hemorrhagic complication after LT. We retrospectively compared the incidence of adverse events (death, intrathoracic hematoma and bleeding, cardiac congestion or shock, cerebral infarction and pulmonary embolism) within 30 days after LT between no/short-term (median 0.6 years, n = 13) and long-term (median 3.7 years, n = 15) intravenous prostacyclin groups. There were no differences in the dose of intravenous prostacyclin and pulmonary artery pressure between the two groups. Among 22 adverse events (0.8 ± 1.1 events/patient), 4 events occurred in the no/short-term intravenous prostacyclin group and 18 occurred in the long-term intravenous prostacyclin group. The event rate per patient in the long-term intravenous prostacyclin group (1.2 ± 1.3 events/patient) was significantly higher than that in the no/short-term intravenous prostacyclin group (0.3 ± 0.5 events/patient) (P < 0.05). Intrathoracic hematoma and bleeding was the most frequent adverse event (9 events, 41%). Preoperative long-term intravenous prostacyclin therapy increases acute adverse cardiovascular events after LT in patients with PAH.

Original languageEnglish
Pages (from-to)557-561
Number of pages5
JournalInternational Heart Journal
Volume58
Issue number4
DOIs
Publication statusPublished - Aug 2 2017

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Lung Transplantation
Epoprostenol
Pulmonary Hypertension
Hemorrhage
Hematoma
Intracranial Embolism
Cerebral Infarction
Pulmonary Embolism
Thrombocytopenia
Pulmonary Artery
Shock
Therapeutics
Pressure
Mortality
Incidence

Keywords

  • Cardiovascular complication
  • Epoprostenol
  • Intrathoracic hematoma and bleeding

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "High frequency of acute adverse cardiovascular events after lung transplantation in patients with pulmonary arterial hypertension receiving preoperative long-term intravenous prostacyclin",
abstract = "Adverse cardiovascular events after lung transplantation (LT) increase the mortality in patients with pulmonary arterial hypertension (PAH). Long-term intravenous prostacyclin is the usual treatment in severe patients with PAH, but it may increase the risk of hemorrhage due to its antiplatelet aggregation effect or thrombocytopenia. We investigated the impact of length of intravenous prostacyclin therapy on acute adverse cardiovascular events including hemorrhagic complication after LT. We retrospectively compared the incidence of adverse events (death, intrathoracic hematoma and bleeding, cardiac congestion or shock, cerebral infarction and pulmonary embolism) within 30 days after LT between no/short-term (median 0.6 years, n = 13) and long-term (median 3.7 years, n = 15) intravenous prostacyclin groups. There were no differences in the dose of intravenous prostacyclin and pulmonary artery pressure between the two groups. Among 22 adverse events (0.8 ± 1.1 events/patient), 4 events occurred in the no/short-term intravenous prostacyclin group and 18 occurred in the long-term intravenous prostacyclin group. The event rate per patient in the long-term intravenous prostacyclin group (1.2 ± 1.3 events/patient) was significantly higher than that in the no/short-term intravenous prostacyclin group (0.3 ± 0.5 events/patient) (P < 0.05). Intrathoracic hematoma and bleeding was the most frequent adverse event (9 events, 41{\%}). Preoperative long-term intravenous prostacyclin therapy increases acute adverse cardiovascular events after LT in patients with PAH.",
keywords = "Cardiovascular complication, Epoprostenol, Intrathoracic hematoma and bleeding",
author = "Satoshi Akagi and Takahiro Oto and Motomu Kobayashi and Kentaroh Miyoshi and Seiichiro Sugimoto and Masaomi Yamane and Kazufumi Nakamura and Toshihiro Sarashina and Shinichiro Miyoshi and Hiroshi Ito",
year = "2017",
month = "8",
day = "2",
doi = "10.1536/ihj.16-389",
language = "English",
volume = "58",
pages = "557--561",
journal = "International Heart Journal",
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T1 - High frequency of acute adverse cardiovascular events after lung transplantation in patients with pulmonary arterial hypertension receiving preoperative long-term intravenous prostacyclin

AU - Akagi, Satoshi

AU - Oto, Takahiro

AU - Kobayashi, Motomu

AU - Miyoshi, Kentaroh

AU - Sugimoto, Seiichiro

AU - Yamane, Masaomi

AU - Nakamura, Kazufumi

AU - Sarashina, Toshihiro

AU - Miyoshi, Shinichiro

AU - Ito, Hiroshi

PY - 2017/8/2

Y1 - 2017/8/2

N2 - Adverse cardiovascular events after lung transplantation (LT) increase the mortality in patients with pulmonary arterial hypertension (PAH). Long-term intravenous prostacyclin is the usual treatment in severe patients with PAH, but it may increase the risk of hemorrhage due to its antiplatelet aggregation effect or thrombocytopenia. We investigated the impact of length of intravenous prostacyclin therapy on acute adverse cardiovascular events including hemorrhagic complication after LT. We retrospectively compared the incidence of adverse events (death, intrathoracic hematoma and bleeding, cardiac congestion or shock, cerebral infarction and pulmonary embolism) within 30 days after LT between no/short-term (median 0.6 years, n = 13) and long-term (median 3.7 years, n = 15) intravenous prostacyclin groups. There were no differences in the dose of intravenous prostacyclin and pulmonary artery pressure between the two groups. Among 22 adverse events (0.8 ± 1.1 events/patient), 4 events occurred in the no/short-term intravenous prostacyclin group and 18 occurred in the long-term intravenous prostacyclin group. The event rate per patient in the long-term intravenous prostacyclin group (1.2 ± 1.3 events/patient) was significantly higher than that in the no/short-term intravenous prostacyclin group (0.3 ± 0.5 events/patient) (P < 0.05). Intrathoracic hematoma and bleeding was the most frequent adverse event (9 events, 41%). Preoperative long-term intravenous prostacyclin therapy increases acute adverse cardiovascular events after LT in patients with PAH.

AB - Adverse cardiovascular events after lung transplantation (LT) increase the mortality in patients with pulmonary arterial hypertension (PAH). Long-term intravenous prostacyclin is the usual treatment in severe patients with PAH, but it may increase the risk of hemorrhage due to its antiplatelet aggregation effect or thrombocytopenia. We investigated the impact of length of intravenous prostacyclin therapy on acute adverse cardiovascular events including hemorrhagic complication after LT. We retrospectively compared the incidence of adverse events (death, intrathoracic hematoma and bleeding, cardiac congestion or shock, cerebral infarction and pulmonary embolism) within 30 days after LT between no/short-term (median 0.6 years, n = 13) and long-term (median 3.7 years, n = 15) intravenous prostacyclin groups. There were no differences in the dose of intravenous prostacyclin and pulmonary artery pressure between the two groups. Among 22 adverse events (0.8 ± 1.1 events/patient), 4 events occurred in the no/short-term intravenous prostacyclin group and 18 occurred in the long-term intravenous prostacyclin group. The event rate per patient in the long-term intravenous prostacyclin group (1.2 ± 1.3 events/patient) was significantly higher than that in the no/short-term intravenous prostacyclin group (0.3 ± 0.5 events/patient) (P < 0.05). Intrathoracic hematoma and bleeding was the most frequent adverse event (9 events, 41%). Preoperative long-term intravenous prostacyclin therapy increases acute adverse cardiovascular events after LT in patients with PAH.

KW - Cardiovascular complication

KW - Epoprostenol

KW - Intrathoracic hematoma and bleeding

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U2 - 10.1536/ihj.16-389

DO - 10.1536/ihj.16-389

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C2 - 28690295

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VL - 58

SP - 557

EP - 561

JO - International Heart Journal

JF - International Heart Journal

SN - 1349-2365

IS - 4

ER -