Actelion · PTGIR · Small Molecule
epoprostenol is a small molecule developed by Actelion. It is approved for therapeutic indications via injectable (others) or intravenous (iv).
| Brand Names | Caripul |
| Company | Actelion |
| Drug Class | Small Molecule |
| Molecular Target | PTGIR |
| Route | Injectable (Others), Intravenous (IV) |
| Status | Approved |
epoprostenol acts on 1 molecular target:
| PTGIR | prostaglandin I2 receptor (IP, PRIPR) |
epoprostenol is developed for 1 unique indication across 1 therapeutic area.
| Therapeutic Area | Condition | Phase |
|---|---|---|
| Respiratory, thoracic and mediastinal disorders | Pulmonary hypertension | ✓ Approved |
Kassels Alexa A, Ghassemzadeh Kimiya K, Ederaine Sophia S, Horton Luke L et al.
Tran Minh-Ha MH, Trinh Mindy M, Trinh Evan E, Dang Phat P et al.
To systematically review the efficacy and safety of prostacyclin analogs used to permit heparin anticoagulation during cardiopulmonary bypass (CPB) in patients with heparin-induced thrombocytopenia (HIT). We conducted a systematic review of PubMed and Scopus. Studies describing iloprost or epoprostenol use to permit heparinization during CPB were included. Efficacy and safety outcomes were analyzed by using descriptive statistics. Published literature. Patients with HIT or suspected HIT undergoing CPB with prostacyclin-assisted heparin anticoagulation. Iloprost or epoprostenol administration to inhibit platelet function and permit heparin anticoagulation during CPB, followed by protamine reversal. Of 172 identified records, 23 studies encompassing 207 patients met inclusion criteria. Iloprost dosing was more variable and more frequently titrated using platelet function testing than epoprostenol dosing. Both agents permitted heparinization and protamine reversal. Norepinephrine, phenylephrine, vasopressin, and epinephrine use to manage prostacyclin-mediated hypotension was reported in 14 of 17 (82.3%), 4 of 18 (22.2%), 3 of 16 (18.8%), and 2 of 16 (12.5%) studies, respectively. Transfusion occurred in 122 of 207 patients (58.9%), thrombotic outcomes in 17 of 207 (8.2%), and mortality in 18 of 207 (8.7%). Only 1 of 207 patients (0.5%) experienced thrombosis during CPB; the remaining thrombotic events occurred after CPB. Prostacyclin-assisted heparin anticoagulation can permit CPB and protamine reversal in patients with HIT requiring urgent surgery. Although prostacyclin-mediated hypotension frequently necessitates vasopressor support, intraoperative thrombotic events appear uncommon.
Ogo Takeshi T, Hayashi Hiroya H, Takano Ryo R, Fujisaki Shinya S et al.
Li Yuanteng Jeff YJ, Buni Maryam M, Tayar Jean H JH, Lu Huifang H et al.
Although immune checkpoint inhibitors (ICIs) have improved oncological outcomes, they can cause a myriad of inflammatory conditions known as immune-related adverse events (irAEs). Raynaud's phenomenon (RP) is a rare rheumatologic irAE that may arise de novo or present as an exacerbation of preexisting disease. This case series aims to describe ICI-induced RP in patients without a rheumatological diagnosis seen at a large, specialized cancer center. Our case series describes five patients with ICI-induced RP who were evaluated by rheumatology at a cancer center during the past 3 years where their cancers, type of ICIs, diagnostic tests, and treatments are discussed in detail. Among our five patients, one patient had preexisting psoriatic arthritis, and one had preexisting RP. The outcome of our patients' ICI-induced RP varied widely. Although three patients had significant digital ischemia resulting in ulceration requiring epoprostenol infusions, the remaining two patients had mild digital ischemia that were controlled conservatively. However, none of our patients had clinical features to suggest systemic sclerosis (SSc), where RP is often the first symptom. Interestingly, interferon-γ and interleukin-6 were the most frequently elevated cytokines when checked in these patients. This is the first case series, to the authors' knowledge, to describe ICI-induced RP, which may occur without other clinical features of an autoimmune rheumatological disease. The severity of the disease may vary, but it warrants increased awareness and prompt initiation of appropriate treatment.
Eyduran Eda E, İyi Duygu D, Aslan Ayşen Durak AD, Huseyinova Ulkar U et al.
Acute kidney injury (AKI) is a significant complication in pediatric liver transplant (LT) patients. This is often exacerbated by liver dysfunction, fluid overload, and metabolic disturbances. Intraoperative continuous kidney replacement therapy (IO-CKRT) is an emerging strategy to manage these complex patients, aiming to stabilize fluid, electrolyte, and acid-base imbalances. Epoprostenol is utilized as an anticoagulant during CKRT to maintain circuit patency, particularly in patients at high risk of bleeding by inhibiting platelet aggregation. However, the use of IO-CKRT with epoprostenol specifically in pediatric LT recipients is poorly documented. We present a case of a 12 year-old girl with biliary atresia and cirrhosis who underwent urgent LT from a deceased donor. She developed hemorrhagic shock and multi-organ failure, necessitating pre-transplant plasmapheresis and subsequent CKRT with epoprostenol. IO-CKRT was maintained during the 12 h LT to manage acid-base balance, electrolyte levels, and volume status. Despite epoprostenol anticoagulation for hemofiltration, no abnormal bleeding occurred in the gastrointestinal or surgical areas during transplantation. Post-transplantation, the patient's inotropic support requirements decreased within 24 h. IO-CKRT effectively achieves fluid and metabolic balance during LT in pediatric patients with AKI, fluid overload, and metabolic issues. Epoprostenol proves to be a safe and effective regional anticoagulation option for CKRT in bleeding patients undergoing LT, preventing site bleeding without systemic complications. This case highlights a unique and important application that warrants further investigation into its broader effectiveness and potential complications in this vulnerable patient population.
Tan Li H LH, Paul Eldho E, Simpson Alex A, Marasco Silvana S et al.
To determine the documentation of right ventricular dysfunction (RVD) in mechanically ventilated patients receiving a noradrenaline infusion, and to assess the association with in-hospital mortality, length of stay (LOS) and treatment intensity. This single-centre, retrospective, observational cohort study included patients admitted to the intensive care unit (ICU) between January 2020 and December 2023, with elevated serum lactate levels, who received invasive mechanical ventilation and an intravenous noradrenaline infusion, within the first 7 days. Exposure was defined on the basis of documentation of RVD in the medical record; e.g. those with RVD vs those without RVD. The primary outcome was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital LOS, organ support modalities, and the utilisation of echocardiography. Comparison between groups utilised logistic and linear regression models. Of 1234 patients included in the study, 273 had documented RVD (22.1%). There was no difference in crude in-hospital mortality (RVD, 24.9% vs no RVD, 23.6% p = 0.66) between groups. Risk-adjusted in-hospital (odds ratio [OR]: 1.65: 1.13-2.41, p = 0.01) and ICU mortality (OR: 1.88: 1.26-2.81, p = 0.002) were greater in those with documented RVD. Median ICU (13.4 vs 10.2 days, p = 0.001) and hospital (25.1 vs 22.5 days, p = 0.002) LOS were significantly longer in the RVD group. A greater number of interventions were provided in those with RVD, including: inhaled nitric oxide (39.6% vs 7.8%, p < 0.001), epoprostenol (1.8% vs 0.1%, p < 0.001), milrinone infusion (77.3% vs 23.6%, p < 0.001), continuous renal replacement therapy (48.7% vs 25.8%, p < 0.001), and extracorporeal membrane oxygenation (33.7% vs 10.4%, p < 0.001). The median number of transthoracic (TTE) or transoesophageal echocardiography (TOE) was 3 (interquartile range [IQR]: 1-4) in those with RVD, compared to 1 (IQR: 1-2) in those without RVD (p < 0.001). Approximately 1 in 4 patients who were mechanically ventilated and receiving noradrenaline had documented RVD, which was associated with a higher risk-adjusted in-hospital mortality, longer LOS, and greater treatment intensity.
+1225 more articles available with a free account
Sign up free to view all articles →