Key result
Preoperative ACE inhibition with ramipril increased intraoperative bradykinin and t-PA concentrations compared to ARB, enhancing fibrinolysis without affecting the inflammatory response.
Why the study?
Does preoperative ACE inhibition or ARB alter fibrinolytic and inflammatory responses in patients undergoing cardiopulmonary bypass?
RCT
Does preoperative ACE inhibition or ARB alter fibrinolytic and inflammatory responses in patients undergoing cardiopulmonary bypass?
Continuing ACE inhibitors or ARBs before cardiopulmonary bypass appears safe, with ACE inhibitors enhancing fibrinolysis and reducing hospital stay.
Supports continuing ACE inhibitors preoperatively in cardiopulmonary bypass; extends evidence for enhanced fibrinolysis versus ARBs without inflammatory impact.
The effects of angiotensin-converting enzyme (ACE) inhibition and angiotensin II type 1 receptor blockade (ARB) on fibrinolysis and inflammation after cardiopulmonary bypass (CPB) are uncertain. This study tested the hypothesis that ACE inhibition enhances fibrinolysis and inflammation to a greater extent than ARB in patients undergoing CPB. One week to 5 days before surgery, patients were randomized to ramipril 5 mg/day, candesartan 16 mg/day, or placebo. ACE inhibition increased intraoperative bradykinin and tissue-type plasminogen activator (t-PA ) concentrations as compared to AR B. Both ACE inhibition and AR B decreased the need for plasma transfusion relative to placebo, but only ACE inhibition decreased the duration of hospital stay. Neither ACE inhibition nor AR B significantly affected concentrations of plasminogen activator inhibitor-1 (PAI -1), interleukin (IL )-6, IL -8, or IL -10. ACE inhibition enhanced intraoperative fibrinolysis without increasing the likelihood of red-cell transfusion. By contrast, neither ACE inhibition nor ARB affected the inflammatory response. ACE inhibitors and ARBs may be safely continued until the day of surgery.
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Billings et al. (2012) conducted an RCT in Cardiopulmonary bypass (CPB). Ramipril or Candesartan vs. Placebo was evaluated on Fibrinolysis and inflammation (intraoperative bradykinin, t-PA, PAI-1, IL-6, IL-8, IL-10). Preoperative ACE inhibition with ramipril increased intraoperative bradykinin and t-PA concentrations compared to ARB, enhancing fibrinolysis without affecting the inflammatory response.
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