The safety of dipyridamole in patients undergoing myocardial perfusion scintigraphy prior to lung volume reduction surgery

Abstract

Patients with end-stage chronic obstructive pulmonary disease (COPD) undergoing lung volume reduction surgery (LVRS) are at high risk of peri-operative cardiac complications, and myocardial perfusion scintigraphy (MPS) is commonly used for risk stratification. This study prospectively assessed the safety of dipyridamole in these patients and compared the incidence of side-effects (particularly dyspnoea) with that in patients undergoing dipyridamole MPS prior to elective non-cardiothoracic surgery. Fifty patients were enrolled: 25 in the LVRS cohort (13 males, 12 females), with a mean age of 65 years and a mean FEV1 of 0.791, and 25 (with no history of asthma or COPD) in the control cohort (14 males, 11 females), with a mean age of 66 years. Fourteen patients (56%) in each group developed side-effects. Dyspnoea was reported by five patients (20%) in the LVRS and two patients (8%) in the control cohort (P=NS). One patient in each cohort developed severe hypotension and bradycardia. Eight (32%) other patients developed minor side-effects in the LVRS cohort compared with 11 (44%) in the control group. All side-effects responded promptly to intravenous aminophylline. In summary, there was a statistically non-significant increase in the incidence of dyspnoea in patients with end-stage COPD and all side-effects responded to aminophylline. Thus, dipyridamole can be used safely in these patients.

Dyspnoea after antiplatelet agents: the AZD6140 controversy

“…Nevertheless, anecdotal evidence has suggested that aspirin (2), ticlopidine (3,4), clopidogrel (5), cilostazol (6), abciximab (7) or eptifibatide (8) may cause dyspnoea. There are numerous observations linking dipyridamole with dyspnoea, but all cases occur during diagnostic perfusion cardiac imaging, and are not attributed to with Aggrenox (extended released dipyridamole combined with low‐dose aspirin) approved for secondary stroke prevention (9,10). There are no data that therapy with tirofiban has been associated with dyspnoea.…”

The safety and tolerability of adenosine in patients with obstructive airways disease

“…Dipyridamole is thought to act by blocking the reuptake of adenosine, and its safety in patients without airways disease undergoing myocardial perfusion imaging has been established [1,2]. Controversy exists regarding the safety and tolerability of dipyridamole in patients with severe COPD however [3,4], and it is contraindicated in patients with asthma [5].…”

Dipyridamole May Induce Migraine in Patients With Migraine Without Aura

“…Dipyridamole appears to work through two different signalling systems, the cAMP- and the cGMP-related pathways (3, 4). The most common side-effect in the clinical use of dipyridamole is headache occurring in approximately 38% after oral administration, causing discontinuation of treatment in 8% of patients (5) and occurring in 32–37% after routine intravenous administration (6, 7).…”