An update on nitrate tolerance: can it be avoided?

Maxwell, Scott; Kendall, M. J.

doi:10.1136/pgmj.68.805.857

Cited by 7 publications

(3 citation statements)

References 63 publications

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“…However, this strategy has been viewed with caution because of the potential rebound risk and consequent outcomes (e.g., myocardial infraction and death). 61 , 62 The use of sulfhydryl donor therapy (e.g., acetylcholine, methionine, and captopril) has similarly been associated with undesirable adverse events.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

et al. 2018

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BackgroundPostoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass graft (CABG) surgery. This arrhythmia occurs more frequently among patients who receive perioperative inotropic therapy (PINOT). Administration of nitrates with antiplatelet agents reduces the conversion rate of cyclic guanosine monophosphate to guanosine monophosphate. This process is associated with increased concentrations of free radicals, catecholamines, and blood plasma volume. We hypothesized that patients undergoing CABG surgery who receive PINOT may be more susceptible to POAF when nitrates are administered with antiplatelet agents.MethodsClinical records were examined from a prospectively maintained cohort of 4,124 patients undergoing primary isolated CABG surgery to identify POAF-associated factors.ResultsPOAF risk was increased among patients receiving PINOT, and the greatest effect was observed when nitrates were administered with antiplatelet therapy. Adjustment for comorbidities did not substantively change the study results.ConclusionsAdministration of nitrates with certain antiplatelet agents was associated with an increased POAF risk among patients undergoing CABG surgery. Additional studies are needed to determine whether preventive strategies such as administration of antioxidants will reduce this risk.

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Section: Discussionmentioning

confidence: 99%

Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

et al. 2018

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“…In other words Bayes factors are transitive. Using this result, and the clear fact that Bij = l/Bji, we may use (26)- (28) to derive the following Bayes factors: For the GTN consumption data we obtain the following Bayes factors: which for the present data gives P(r > 0 I Y) = 0.875, suggesting that there is no overwhelming evidence for a difference between treatments. It is tempting to suppose that with the calculation of the above, unconditional, posterior probability the analysis is complete with the exception of providing the unconditional posterior density of the treatment effect, p ( t l Y), as we show in Figure 2 together with the conditional posterior densities.…”

Section: We Havementioning

confidence: 68%

Extending a Bayesian analysis of the two‐period crossover to allow for baseline measurements

Grieve

1994

Statistics in Medicine

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“…However, their use is associated with the development of tolerance and a loss of efficacy (Maxwell & Kendall 1992). However, their use is associated with the development of tolerance and a loss of efficacy (Maxwell & Kendall 1992).…”

Section: Discussionmentioning

confidence: 99%

Isosorbide Dinitrate Solution Spray in Exercise-Induced Angina Pectoris

1993

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The effects of a new formulation of isosorbide dinitrate (ISDN) spray (1.25 and 2.5mg) on exercise-induced anginal symptoms and ischaemic ST-segment changes were studied in a randomised, double-blind, placebo-controlled, crossover study in 20 patients with stable angina pectoris. ISDN spray at both doses reduced ST-segment depression at the highest common workload by 64% (p < 0.001), whereas there was only a slight reduction after administration of placebo

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An update on nitrate tolerance: can it be avoided?

Cited by 7 publications

References 63 publications

Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

Extending a Bayesian analysis of the two‐period crossover to allow for baseline measurements

Isosorbide Dinitrate Solution Spray in Exercise-Induced Angina Pectoris

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