Key result
Prophylactic terlipressin infusion significantly reduced the incidence of vasoplegic syndrome compared to placebo (4% vs 30%) in patients on angiotensin II receptor antagonists undergoing CABG.
Why the study?
Preoperative renin-angiotensin system antagonist use is an independent risk factor for vasoplegic syndrome, but the efficacy of prophylactic terlipressin infusion in patients on ARBs undergoing CABG remained unproven.
Does prophylactic terlipressin infusion prevent vasoplegic syndrome in patients treated with angiotensin II receptor antagonists undergoing coronary artery bypass graft surgery?
RCT (n=100)
Single-blind
Computer-generated sequence
No
Does prophylactic terlipressin infusion prevent vasoplegic syndrome in patients treated with angiotensin II receptor antagonists undergoing coronary artery bypass graft surgery?
Absolute Event Rate: 4% vs 30%
p-value: p=<0.001
Prophylactic terlipressin infusion significantly reduces the incidence of vasoplegic syndrome and the need for postoperative vasopressors in patients on ARBs undergoing CABG.
Background and objectives Preoperative use of renin angiotensin system antagonists has been considered an independent risk factor for development of vasoplegic syndrome. The aim of this study was to demonstrate efficacy of prophylactic terlipressin infusion for prevention of vasoplegic syndrome in patients treated with angiotensin receptor blocker undergoing coronary artery bypass graft surgery. Patients and methods One hundred patients on angiotensin II receptor antagonist [losartan] scheduled for coronary artery bypass surgery were enrolled into this prospective randomized controlled study. Anesthetic technique, surgical technique, and cardiopulmonary bypass management were standardized for all patients. With the start of rewarming, patients were randomized to receive either terlipressin infusion 1.3 μg.kg −1 .hour −1 , or normal saline infusion. Incidence of vasoplegic syndrome score was used as primary outcome. Hemodynamic parameters, inotropic score, and vasopressor dependency index were used as secondary outcome. Results Incidence of vasoplegic syndrome was significantly lower in terlipressin group compared to placebo group. Norepinephrine was required in 2 patients of terlipressin versus 15 patients of placebo group. Mean arterial blood pressure was significantly higher in terlipressin group compared to placebo group (81.7 ± 18.5 versus 69.3 ± 20.2 at 60 min after weaning from CBP). Cardiac index was significantly lower in terlipressin group compared to placebo group (2.52 ± 1.48 versus 3.2 ± 1.55). Systemic vascular resistance was significantly higher in terlipressin group compared to placebo group (2438.09 ± 735.13 versus 1575.05 ± 753.54). Inotropic score and vasopressor dependency index were significantly lower in terlipressin group compared to placebo group. Conclusion Prophylactic terlipressin infusion could prevent development of vasoplegic syndrome in patients treated with angiotensin II receptor antagonist undergoing coronary artery bypass graft surgery. Trial registration PACTR, PACTR201804003249274, Registered 25/03/2018—retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3249 .
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Saleh et al. (2020) conducted an RCT in Patients on angiotensin II receptor antagonist scheduled for coronary artery bypass graft surgery (n=100). Terlipressin vs. Normal saline infusion was evaluated on Incidence of vasoplegic syndrome (p=<0.001). Prophylactic terlipressin infusion significantly reduced the incidence of vasoplegic syndrome compared to placebo (4% vs 30%) in patients on angiotensin II receptor antagonists undergoing CABG.
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