Efficacy of Tolvaptan on Fluid Management After Cardiovascular Surgery Using Cardiopulmonary Bypass

Efficacy of tolvaptan for fluid management after cardiovascular surgery: A systematic review and meta‑analysis of randomized control trials

“…The authors of that study found tolvaptan to be an effective diuretic without causing electrolyte disbalance or worsening of renal function. Other published retrospective observational studies have also reported similar results ( 7-9 ). However, a significant limitation of observational studies is the high risk of bias.…”

“…A total of 11 studies were screened by their full text. Five were excluded as they were not RCTs (1,7,9,13,14). One study was conducted on pediatric patients (15), and another on patients with chronic kidney disease (8).…”

“…Due to its beneficial pharmacological properties, tolvaptan has been approved for managing heart failure patients with numerous studies establishing its efficacy and safety profile ( 6 ). Over the last decade, researchers have also evaluated the efficacy of tolvaptan for postoperative fluid management in cardiac surgery ( 1 , 7 ). In one of the earliest studies, Nishi et al ( 1 ) compared a prospective cohort of 64 heart valve patients managed using tolvaptan with a historic control group of 55 patients managed with conventional diuretics.…”

Advent of New perioperative care for fluid management after cardiovascular surgery: A review of current evidence

“…The biggest concern of administration of tolvaptan is hypernatremia. Several studies investigated the incidence and clinical impact of hypernatremia [36][37][38][39][40][41][42]. Most studies showed that hypernatremia (>150 mEq/L) did not occur after each protocol.…”

Tolvaptan—New Opportunity in Fluid Management After Cardiopulmonary Bypass

“…2 Finally, tolvaptan might be a promising candidate in optimizing fluid management after major surgery. 3,4 Patients undergoing cardiac surgery with the help of cardiopulmonary bypass (CPB) are prone to exaggerated positive fluid balance, 5 which might contribute to increased postoperative morbidity, including acute kidney injury (AKI) and mortality. 6 Activation of the inflammatory cascade leading to impaired vascular integrity, destruction of the endothelial glycocalyx with increased vascular permeability, and excessive fluid load are often unavoidable in the perioperative period and contribute to volume overload and fluid retention in the interstitial compartment after cardiac surgery.…”