Beraprost Sodium-Induced Hypotension in Two Patients After Cardiac Surgery

Abstract

SUMMARYTwo episodes of hypotension caused by oral beraprost sodium administration following cardiac surgery are described. The first case was a 67-year-old female who underwent concomitant surgery for mitral valve replacement, tricuspid annuloplasty, and a radiofrequency maze procedure for atrial fibrillation. The second case was a 45-year-old female who underwent 4-vessel coronary artery bypass grafting associated with endarterectomy in the right coronary artery. Beraprost sodium was administered for the treatment of residual pulmonary hypertension in the first case, and was initiated as an antiplatelet agent following coronary endarterectomy in the second case. Hypotension occurred at approximately one hour after beraprost sodium administration in both cases. Careful observation to prevent this adverse effect is critical after the administration of beraprost sodium, especially in patients who have undergone cardiac surgery. (Int Heart J 2006; 47: 319-323) Key words: Beraprost sodium, Prostacyclin, Hypotension, Cardiac surgery PROSTACYCLIN (PGI 2 ) and its analogues are potent vasodilators and possess antithrombotic and antiproliferative properties. Beraprost sodium, an oral prostacyclin analogue, has among other effects antiplatelet and vasodilating effects, which have been widely used for patients with pulmonary hypertension and chronic arterial occlusive disease. We describe here 2 episodes of hypotension induced by oral beraprost sodium administration following cardiac surgery, and discuss the clinical use of beraprost sodium and the etiology of this adverse phenomenon. CASE REPORTSCase 1: A 67-year-old female was diagnosed as having mitral valve stenosis (area, 0.79 cm 2 ) and regurgitation (Seller's grade 3), tricuspid valve regurgitation,From the

Dexmedetomidine Pretreatment Confers Myocardial Protection and Reduces Mechanical Ventilation Duration for Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass

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Effect of Dexmedetomidine on Cardiac Surgery Patients

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TRA-418, a thromboxane A2 receptor antagonist and prostacyclin receptor agonist, inhibits platelet-leukocyte interaction in human whole blood

“…Beraprost sodium has been used clinically as an agent to improve peripheral arterial disease, including Buerger's disease (17), and iloprost and treprostinil have been reported to have therapeutic properties in peripheral circulatory disorders (18,19). Although IP agonists have the desired pharmacological effects of vascular endothelial cytoprotection (20) and improvement of the microcirculation (21), it is unreasonable to expect that high doses of IP agonists in the clinical setting would exert a valuable antithrombotic effect, as the adverse effects of hypotension due to vasodilatation would also be increased (19,22). We therefore considered producing a novel antithrombotic agent by combining IP agonistic activ-ity and sufficient TP antagonistic activity and discovered TRA-418, which has Ki values of 0.5 μM and 0.43 μM at the human platelet TP receptor and IP receptor, respectively (11,23).…”