Tolvaptan can limit postoperative paroxysmal atrial fibrillation occurrence after open-heart surgery

Nakamura, Yoshinobu; Kishimoto, Yuichiro; Harada, Shingo; Onohara, Takeshi; Otsuki, Yuki; Horie, Hiromu; Nishimura, Motonobu

doi:10.1007/s00595-020-01962-3

Cited by 6 publications

(15 citation statements)

References 20 publications

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“…It is the only ADH inhibitor available in Europe. It has been shown to be useful in hyponatremia associated with SIADH of any etiology, and in hyponatremia associated with heart failure, liver disease (24) and post-operative situations resulting from different surgeries (25).…”

Section: Use Of Tolvaptan In Siadhmentioning

confidence: 99%

Management of hyponatremia associated with acute porphyria—proposal for the use of tolvaptan

Solares¹,

Tejedor²,

Jericó³

et al. 2020

Ann Transl Med

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Hyponatremia is a common feature during the neurovisceral acute attacks which characterize hepatic porphyrias, as well as a sign of its severity. Therapeutic options for first-line acute attacks are intravenous administration of glucose and/or exogenous heme. The former treatment can aggravate hyponatremia by dilution and cause seizures; thus, the correction of hyponatremia must be carried out with extreme caution. This review summarizes recommendations for the management of hyponatremia during acute episodes of porphyria. Hyponatremia should be corrected slowly and seizures treated with medications in order to not exacerbate motor and sensory axonal neuropathy. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is considered a frequent cause of hyponatremia in acute porphyrias and must be identified as a symptom of an acute porphyria attack. Tolvaptan produces aquaresis and is considered a safe drug in porphyria. However, its use has only been reported in isolated cases during a porphyria attack. The convenience and usefulness of this drug in acute porphyria are discussed.

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Section: Use Of Tolvaptan In Siadhmentioning

confidence: 99%

Management of hyponatremia associated with acute porphyria—proposal for the use of tolvaptan

Solares¹,

Tejedor²,

Jericó³

et al. 2020

Ann Transl Med

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“…1,6,15,25-29 In contrast, Nakamura et al reported that tolvaptan effectively reduced the amount of furosemide and the incidence of POAF due to improvements in volume overload with low dosages of loop diuretics in the early postoperative period. 10 However, in that study, POAF occurred in 35 (42.2%) patients in the control group, 10 which is higher than the incidence of POAF in the present as a diuretic, tolvaptan can contribute to the maintenance of renal blood flow without activating the renin-angiotensinaldosterone and sympathetic nervous systems. 1,12-14 Hence, using tolvaptan could decrease the total amount of furosemide required, reducing the untoward side effects of furosemide use, such as intravascular dehydration, electrolyte abnormalities, and sympathetic nervous system stimulation.…”

Section: Discussionmentioning

confidence: 72%

“…Therefore, tolvaptan could preserve renal function and help patients achieve an early return to their preoperative body weight without postoperative complications such as WRF and POAF. 10 Several studies have revealed that postoperative management with tolvaptan is effective in terms of renal protection and management of excess body fluid after CVS with CPB. [15][16][17] In addition, tolvaptan administration reduces the amount of furosemide required while maintaining urine output.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with chronic kidney disease, hemodialysis, an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 , low cardiac output with an ejection fraction <40%, an admission related to control groups used >100 mg furosemide, with a POAF rate of >40% in the control group. 10 We hypothesized that even low-dose (3.75 mg/day) tolvaptan, added to low-dose loop diuretics, may maintain adequate urine volume and may be useful in reducing volume without intravascular hypovolemia and postoperative complications. Thus, the present study investigated whether low-dose tolvaptan improves the in-out balance in the early perioperative phase in addition to sparing loop diuretics.…”

Section: Patientsmentioning

confidence: 99%

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Effects of Low-Dose Tolvaptan for Fluid Management After Cardiovascular Surgery

et al. 2022

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Background: Perioperative management of body fluid levels after cardiovascular surgery with cardiopulmonary bypass is essential. Fluid management using tolvaptan with conventional diuretics is effective in maintaining urine output without worsening renal function. This study aimed to improve the in-out balance in the early perioperative phase using low-dose tolvaptan (3.75 mg/day). Methods and Results:This prospective, single-center, randomized, open-label study included 199 patients who underwent cardiovascular surgery with cardiopulmonary bypass in Kobe City Medical Center General Hospital between September 2018 and December 2020. Treatment with tolvaptan and loop diuretics (tolvaptan group; 99 patients) was compared with treatment with loop diuretics alone (control group; 100 patients) to evaluate achievement of preoperative body weight as the primary outcome. Secondary outcomes were urine volume, the incidence of worsening renal function (WRF), and postoperative paroxysmal atrial fibrillation (POAF). There was no significant difference between groups in the return to preoperative body weight on postoperative Day 6. The tolvaptan group had significantly increased urine volume (2,530 vs. 2,150 mL/day) and decreased total furosemide dose (24 vs. 32 mg) compared with the control group. No significant differences were observed in the development of WRF and POAF between the 2 groups. Conclusions:Although low-dose tolvaptan administration did not shorten the time to achieving preoperative body weight, it did significantly increase urine volume without WRF and POAF.

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“…Previous studies have shown no signi cant adverse effects of the drug on the occurrence of complications after thoracotomy (28,29). It has also been recently found that early use of tolvaptan after thoracotomy can reduce the development of paroxytic atrial brillation, possibly due to a lack of activation of the reninangiotensin-aldosterone axis and the sympathetic nervous system (30).…”

Section: Discussionmentioning

confidence: 98%

Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection

Wang

Gao

et al. 2022

Preprint

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Objective: Despite the increasing application of tolvaptan in cardiac surgery, there is no information on the use of tolvaptan in Stanford patients with type A aortic dissection. The objective of this study is to evaluate the clinical effect of tolvaptan in patients with type A aortic dissection after surgery.Methods: A retrospective analysis was performed on 45 patients treated for type A aortic dissection in our hospital from 2018 to 2020, including 21 patients who were treated with Group T and 24 patients who were not treated with Group L. Perioperative data were collected from the hospital's electronic records.Results: Patients receiving tolvaptan did not differ significantly from those on traditional diuretics in terms of the duration of mechanical ventilation, postoperative blood required, length of catecholamine use, or amount of diuretics received (all P> 0.05). The development of new atrial fibrillation was significantly less in the tolvaptan group (P=0.023). Urine volume was slightly, but non-significantly, higher in patients receiving tolvaptan. Serum levels of potassium, creatinine, and urea nitrogen did not differ between the groups in the week after surgery, while that of sodium was significantly higher in the tolvaptan-treated group on day 7 after transfer from the ICU (P=0.001). Sodium levels were also elevated by day 7 in patients receiving traditional diuretics (P=0.001). The serum creatinine and urea nitrogen levels were raised on both days 3 and 7 in both groups (both P<0.05).Conclusions: For patients after acute Stanford type A aortic dissection, both tolvaptan and traditional diuretics are effective and safe. Tolvaptan is more effective in reducing the incidence of postoperative atrial fibrillation. For patients following Acute Stanford A aortic dissection surgery, tolvaptan did not provide a greater advantage over loop diuretics in terms of fluid clearance, but it may reduce the incidence of postoperative atrial fibrillation.

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Tolvaptan can limit postoperative paroxysmal atrial fibrillation occurrence after open-heart surgery

Cited by 6 publications

References 20 publications

Management of hyponatremia associated with acute porphyria—proposal for the use of tolvaptan

Management of hyponatremia associated with acute porphyria—proposal for the use of tolvaptan

Effects of Low-Dose Tolvaptan for Fluid Management After Cardiovascular Surgery

Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection

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