Effects of Losartan on Low‐Density Lipoprotein Apheresis

Kojima, Sunao; Yoshitomi, Yuji; Saotome, Masao; Tanaka, Kyoe; Shida, Mikio; Kuramochi, Morio

doi:10.1046/j.1526-0968.1999.00195.x

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…Switching to angiotensin receptor blocker, such as losartan, may be an option. Yet, losartan has been shown to increase bradykinin level without significant hypotension and AEs during lipid apheresis 14 …”

Section: Discussionmentioning

confidence: 99%

Use of angiotensin converting enzyme inhibitors in patients receiving therapeutic plasma exchange with a centrifuge‐based apheresis system

et al. 2020

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Angiotensin‐converting enzyme inhibitors (ACEi) are frequently used antihypertensive medications with additional advantages such as reducing proteinuria and cardiovascular events. ACEi are commonly held at least 24 hours before a therapeutic plasma exchange (TPE) to reduce possibility of adverse events (AEs) including adverse drug reactions (ADR). The objective of this study was to determine if ACEi use increases the risk of ADR in patients receiving TPE with a conventional centrifuge‐based apheresis system. This is a retrospective chart review study (n = 252; 52% male). Binary logistic regression was used to analyze the association of ACEi use and AEs. Of 171 patients who had AE during TPE, only 38 patients were taking ACEi. There was no significant association between ACEi use and AEs after adjustments (odds ratio = 0.885, 95% confidence interval: 0.468, 1.674). Our results suggest that risk of AEs is not higher in patients taking ACEi receiving TPE using a centrifuge‐based machine. Randomized controlled prospective trials may be needed to further investigate this matter.

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Section: Discussionmentioning

confidence: 99%

Use of angiotensin converting enzyme inhibitors in patients receiving therapeutic plasma exchange with a centrifuge‐based apheresis system

et al. 2020

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“…Although we and others [13,23] reported some differences between various methods, the clinical significance is yet unproven. Blockade of the renin-angiotensin system is needed in many patients, and if DSA or DALI apheresis are used, then it should be done only by angiotensin receptor blockers because administration of angiotensin converting enzyme inhibitors is associated with untoward effects due to disturbances in the bradykinin pathway [24,25].…”

Section: Discussionmentioning

confidence: 99%

Homozygous familial hypercholesterolemia: Long term clinical course and plasma exchange therapy for two individual patients and review of the literature

Beigel

2009

J of Clinical Apheresis

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Familial hypercholesterolemia (FH) is an autosomal dominant disease. Homozygous FH (HFH) manifests with severe hypercholesterolemia since birth (cholesterol levels >5-6 the upper normal limit), which, if untreated, leads to early onset accelerated atherosclerosis and premature coronary death, usually before the 2nd or 3rd decades of life. Various invasive procedures (iliocecal bypass, porto-caval shunt, liver transplant, and gene therapy) have been introduced for lowering low density lipoprotein (LDL) aiming at reducing atherosclerosis and improving survival of HFH patients. Of all the various methods, LDL apheresis has become the most attractive. Although its impressive effect on LDL-C reduction is well established, its long-term (of more than 10 year) effect on the atherosclerotic process and specifically cardiac end-points in HFH is hardly documented. We herewith report on the longest term lipophoresis so far reported in two HFH patients, each treated with plasma-exchange and LDL-apheresis for more than 20 years. The observations provide an opportunity to focus on various aspects regarding not only the procedure itself but also its effect on various clinical endpoints. By this description together with reviewing the literature, we discuss several issues, some of them are generalized while others are individualized, dealing with the approach of long term LDL apheresis in HFH.

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“…These patients had suffered from severe hypotensive episodes when treated with DSC while they were on ACE inhibitor medication. After their ACE inhibitors had been replaced by chronic ARA medication, further DSC LDL‐apheresis sessions were uneventful (15–18).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of DALI‐LDL‐Apheresis in Two Patients Treated with the Angiotensin II‐Receptor 1 Antagonist Losartan

Bosch

Wendler

2004

Ther Apher Dial

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Direct adsorption of lipids (DALI) is the first low-density lipoprotein (LDL)-apheresis technique capable of adsorbing LDL and lipoprotein (a) directly from whole blood. The adsorber consists of negatively charged polyacrylate ligands linked to a Eupergit matrix. Negatively charged ligands give rise to activation of bradykinin, which is rapidly degraded by the angiotensin converting enzyme (ACE). Thus, angiotensin converting enzyme inhibitors are contraindicated in DALI-LDL-apheresis. This is the first paper to describe the efficacy and safety of DALI-LDL-apheresis in patients treated with 50 mg of the angiotensin II-receptor 1 antagonist (ARA) losartan. Two hypercholesterolemic patients were treated for 79 patient months with weekly or biweekly DALI sessions (N = 221 sessions). Approximately 1.4 patient blood volumes were treated per session. Acute reductions of LDL-cholesterol (63%) and lipoprotein (a) (62%) exceeded 60% and laboratory safety parameters remained in the apheresis typical range. Mean bradykinin plasma levels peaked in the efferent line post-adsorber at 1000 mL of treated blood volume; 467 fmol/mL (N = 6 sessions) in the ARA-treated patients and 671 fmol/mL (N = 9 sessions) in a control group of three DALI patients without ARA medication (P = 0.69, n.s.). Clinically, the DALI sessions for the ARA-treated patients were completely uneventful and blood pressure was not significantly different in the two groups. In summary, according to this retrospective pilot study, DALI-LDL-apheresis was shown for the first time to be safe and effective in patients on ARA medication.

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Effects of Losartan on Low‐Density Lipoprotein Apheresis

Cited by 6 publications

References 10 publications

Use of angiotensin converting enzyme inhibitors in patients receiving therapeutic plasma exchange with a centrifuge‐based apheresis system

Use of angiotensin converting enzyme inhibitors in patients receiving therapeutic plasma exchange with a centrifuge‐based apheresis system

Homozygous familial hypercholesterolemia: Long term clinical course and plasma exchange therapy for two individual patients and review of the literature

Efficacy and Safety of DALI‐LDL‐Apheresis in Two Patients Treated with the Angiotensin II‐Receptor 1 Antagonist Losartan

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