ACE inhibitors and LDL-apheresis with dextran sulphate adsorption

Kroon, A.A.; Mol, M.J.T.M.; Stalenhoef, A.F.H.

doi:10.1016/0140-6736(92)92673-4

Cited by 34 publications

(18 citation statements)

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“…The most common adverse effects are post-treatment bleeding from needle stick sites and vasovagal reactions [11]. An additional anaphylactoid reaction caused by significant increases of bradykinin in patients on concomitant ACE inhibitor therapy has been described [12]. The negatively charged components of the LDL-apheresis system appear to cause contact activation of the kallikrein-kinin system, which results in extreme production of bradykinin.…”

Section: Discussionmentioning

confidence: 98%

Anaphylactoid‐like reactions in a patient with HyperLp(a)lipidemia undergoing LDL apheresis with dextran sulfate adsorption and herbal therapy with the spice turmeric

Adamski

Jamensky

Ross

et al. 2010

J of Clinical Apheresis

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Elevated Lipoprotein (a) (Lp(a)) levels are associated with atherosclerosis and are independent risk factors for coronary artery disease and stroke [Ariyo et al., N Engl J Med 2003;349:2108–2115; Price et al., Atherosclerosis 2001;157:241–249]. Low-density lipoprotein (LDL)-apheresis is the most effective therapy for reducing Lp(a) levels [Parker, Chem Phys Lipids 1994;67–68:331–338; Stefanutti et al., Transfus Apher Sci 2010;42:21–26]. Dextran sulfate-cellulose adsorption (Liposorber®) removes both LDL and Lp(a) particles with minimal effect on high-density lipoprotein levels. During the procedure, high levels of bradykinin are generated as the kallikrein-kinin system is activated by contact with the negatively charged dextran-sulfate cellulose [Krieter et al., Artif Organs 2005;29:47–52]. Bradykinin is a potent vasodilator and a substrate of the angiotension converting enzyme (ACE). ACE inhibitors are contraindicated for apheresis procedures because these drugs prevent bradykinin degradation, which causes anaphylatoid reactions characterized by hypotension, bradycardia, dyspnea, and flushing [Owen and Brecher, Transfusion 1994;34:891–894]. Turmeric is a yellow spice that is used as an herbal remedy to treat a myriad of conditions ranging from abdominal pain to pulmonary infections. Scientific investigations of the ethnomedicinal properties of curcumin, the major derivative of turmeric, suggest that this compound has anti-inflammatory, antioxidant, and antineoplastic properties [Lobo et al., J Pharm Pharmacol 2009;61:13–21]. We report a case of a patient undergoing Liposorber® therapy for treatment of hyperLp(a)lipidemia who had three episodes of anaphylactoid-like reactions after starting therapy with the spice turmeric.

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Section: Discussionmentioning

confidence: 98%

Anaphylactoid‐like reactions in a patient with HyperLp(a)lipidemia undergoing LDL apheresis with dextran sulfate adsorption and herbal therapy with the spice turmeric

Adamski

Jamensky

Ross

et al. 2010

J of Clinical Apheresis

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“…6 Of these hypotensive reactions, 88% occurred within 1 hour of the beginning of the transfusion and 82% resolved rapidly after the cessation of transfusion. 10,11 The combination of ACE inhibitors and negatively charged dialysis membranes has been implicated in the development of hypotensive reactions, mainly through the mediation of des-Arg 9 -BK. A significantly increased levels of BK was observed when platelet concentrates were filtered through negatively charged depths filters but not positively charged filters.…”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Acute Hypotensive Transfusion Reaction With Concomitant Use of Angiotensin-Converting Enzyme Inhibitors

Kalra¹,

Palaniswamy²,

Patel³

et al. 2012

American Journal of Therapeutics

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Hypotension can be a manifestation of transfusion reactions, including acute hemolysis, bacterial contamination, transfusion-related acute lung injury, and anaphylaxis. In addition to hypotension, these reactions usually present with other characteristic symptoms and signs. In rare cases, hypotension is the only manifestation of a transfusion reaction. This reaction, characterized by early and abrupt onset of hypotension that resolves quickly once the transfusion is stopped, is referred to as acute hypotensive transfusion reaction (AHTR). We report a case of AHTR observed in a patient on angiotensin-converting enzyme inhibitor therapy. The Naranjo adverse drug reaction probability scale score indicated that the association between angiotensin-converting enzyme inhibitor therapy and AHTR was probable. If a patient on angiotensin-converting enzyme inhibitor therapy develops AHTR, it is important to recognize the need to switch to another class of antihypertensive medication, at least while the patient continues to require transfusion.

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“…There are reports that this reaction may be prevented by discontinuation of ACE inhibitors 24 hours before LDL apheresis. 42,43 …”

Section: Side Effects and Cautionary Measuresmentioning

confidence: 98%

Nonpharmacologic Approaches for the Treatment of Hyperlipidemia

Kermani

Frishman²

2005

Cardiology in Review

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Coronary heart disease (CHD) is the leading cause of death in the United States. Dyslipidemias, like decreased high-density lipoprotein (HDL) and increased low-density lipoprotein (LDL), have been linked through epidemiologic and experimental studies with the development of atherosclerosis and an increased risk of CHD. The introduction of various classes of lipid-lowering drugs, especially the hydroxymethylglutaryl-coenzyme-A-reductase inhibitors (statins), has allowed for effective treatment of hyperlipidemia. This article reviews the following nonpharmacologic approaches to hyperlipidemia: LDL apheresis, surgery, the emergence of HDL as a therapeutic target, gene therapy, and finally, the possibility of developing a vaccine against atherosclerosis.

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ACE inhibitors and LDL-apheresis with dextran sulphate adsorption

Cited by 34 publications

References 0 publications

Anaphylactoid‐like reactions in a patient with HyperLp(a)lipidemia undergoing LDL apheresis with dextran sulfate adsorption and herbal therapy with the spice turmeric

Anaphylactoid‐like reactions in a patient with HyperLp(a)lipidemia undergoing LDL apheresis with dextran sulfate adsorption and herbal therapy with the spice turmeric

Acute Hypotensive Transfusion Reaction With Concomitant Use of Angiotensin-Converting Enzyme Inhibitors

Nonpharmacologic Approaches for the Treatment of Hyperlipidemia

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