Comparative effects of angiotensin receptor blockade and ACE inhibition on the fibrinolytic and inflammatory responses to cardiopulmonary bypass.
Clin Pharmacol Ther
; 91(6): 1065-73, 2012 Jun.
Article
em En
| MEDLINE
| ID: mdl-22549281
ABSTRACT
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Tetrazóis
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Benzimidazóis
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Inibidores da Enzima Conversora de Angiotensina
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Ponte Cardiopulmonar
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Ramipril
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Bloqueadores do Receptor Tipo 1 de Angiotensina II
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Fibrinólise
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Inflamação
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article