The intraoperative effect of pentoxifylline on the inflammatory process and                 leukocytes in cardiac surgery patients undergoing cardiopulmonary bypass

Çağlı, Kerim; Ulaş, Murat; Özışık, Kanat; Kale, Arzum; Bakuy, Vedat; Emir, Mustafa; Balcı, Mustafa; Topbaş, Murat; Şener, Erol; Taşdemi̇r, Oğuz

doi:10.1191/0267659105pf779oa

Cited by 23 publications

(3 citation statements)

References 28 publications

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“…Measurements of inflammatory factors (i.e., white blood cell count and differentiation, C-reactive protein, TNF-α and -6) at 6 and 24 hoursIL postoperatively showed a significant reduction in the intervention group compared to the control group[23]. In our study we could not demonstrate significant effect of PTX on CRP in the first 24 hours after surgery.…”

Section: Discussioncontrasting

confidence: 73%

Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin

Barkhordari

Karimi

Shafiee

et al. 2011

J Cardiothorac Surg

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BackgroundBased on Acute Kidney Injury Network (AKIN) criteria, we considered acute kidney injury (AKI) as an absolute increase in the serum creatinine (sCr) level of more than or equal to 0.3 mg/dl or 50%. The introduction of Urinary neutrophil gelatinase-associated lipocalin (UNGAL) has conferred earlier diagnosis of AKI. Pentoxifylline (PTX), a non-specific phosphodiesterase inhibitor, can suppress the production of some factors of inflammatory response and presumably prevent AKI. We examined the PTX on the development of AKI in cardiac surgery patients by measuring the levels of UNGAL.Materials and methodsWe performed a double blind randomized clinical trial, enrolling 28 consecutive patients undergoing elective coronary artery bypass graft (CABG) surgery. Patients were divided into two groups, one to receive PTX 5 mg/kg intravenous bolus injection, followed by 1.5 mg/kg/h continuous intravenous infusion until 3 hours after cessation of CPB and the other group received placebo. UNGAL was measured before, 3 and 24 hours after surgery. In addition serum creatinine was measured before and 24, 48, 72 and 96 hours after surgery and C-reactive protein (CRP) only 24 hours postoperatively.ResultsBoth groups did not differ in demographic and baseline characteristics. 12 patients developed AKI 48 hours after surgery; 5 of them were in the intervention group and 7 in the control group (p= 0.445). There was an increase of UNGAL in both groups postoperatively, although not significant. Mean sCr was significantly increased in the control group at 24 and 48 hours after surgery (24-h mean: 0.79 ± 0.18 mg/dl vs. 1.03 ± 0.43 mg/dl, P value = 0.02; 48-h mean: 1.17 ± 0.24 mg/dl vs. 0.98 ± 0.20 mg/dl, P value = 0.03, respectively). PTX had a positive effect in preventing AKI reflecting in changes in sCr, and the increase of UNGAL was consistent with the emergence of AKI (Pearson's correlation = 0.30).ConclusionOur study demonstrates a weak correlation between UNGAL and sCr after cardiac surgery. The rise of UNGAL in these patients may be reduced by administration of PTX although we did not show significance. PTX could reduce the occurrence of AKI as determined by attenuation of sCr rise without causing hemodynamic instability or increased bleeding. Overall, we suggest future studies with larger sample sizes to elucidate this effect and determine the different aspects of administrating PTX.Trial RegistrationISRCTN: IRCT138807302622N1

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Section: Discussioncontrasting

confidence: 73%

Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin

Barkhordari

Karimi

Shafiee

et al. 2011

J Cardiothorac Surg

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“…74 Owing to its anti-inflammatory properties, preoperative or intraoperative administration of pentoxifylline has been evaluated in a number of small-sized or moderate-sized controlled studies as an adjuvant to CPB. [75][76][77][78][79][80][81][82][83][84][85][86] Pentoxifylline has been administered orally in standard clinical doses for several days prior to surgery, or has been given intravenously at the time of surgery in various dose schedules (eg, 5 mg/kg as a bolus, followed by 1.5 mg/kg/h continuous infusion until 3 h after cessation of CPB). Many of these studies concluded that pentoxifylline administration decreased SIRS after CPB, as assessed by serum levels of proinflammatory cytokines such as TNF-α and IL-6.…”

Section: Slowing Of Progression Of Vascular Dementiamentioning

confidence: 99%

Pentoxifylline for vascular health: a brief review of the literature

2016

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Pentoxifylline is a methylxanthine derivative that has been used for several decades in the symptomatic management of intermittent claudication. For reasons that remain fairly obscure, this drug benefits blood rheology in a number of complementary ways: decreasing blood and plasma viscosity, lowering plasma fibrinogen while promoting fibrinolysis, and improving blood filterability by enhancing erythrocyte distensibility and lessening neutrophil activation. Anti-inflammatory effects on neutrophils and macrophage/monocytes—some of them attributable to pentoxifylline metabolites—appear to play a mediating role in this regard. Although clinical trials with pentoxifylline have often been too small in size to reach statistically significant findings regarding impacts on hard end points, a review of the existing literature suggests that pentoxifylline may have potential for slowing the progression of atherosclerosis, stabilising plaque, reducing risk for vascular events, improving the outcome of vascular events, dampening the systemic inflammatory response following cardiopulmonary bypass, providing symptomatic benefit in angina and intermittent claudication, enhancing cerebral blood flow in patients with cerebrovascular disease while slowing progression of vascular dementia, improving prognosis in congestive heart failure, and aiding diabetes control. This safe and usually well-tolerated drug works in ways quite distinct from other drugs more commonly used for cardiovascular protection, and hence may confer complementary benefit when used in conjunction with them. Major clinical trials of adequate statistical power are now needed to confirm the scope of benefits that pentoxifylline can confer; studies evaluating hard end points in acute coronary syndrome, stroke/transient ischaemic attack and systolic heart failure might be particularly valuable.

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“…Another work in these patients had shown the incidence of multiple organ dysfunction syndrome (MODS) following CPB was 11%, with a mortality rate of 41% [6]. Various studies have investigated different methods to reduce this vigorous inflammatory response following cardiac surgery with CPB; include perioperative administration of corticosteroids [10], aprotinin [11], statins [12], pentoxifylline [13], milrinone [14], ketamine [15], and bovine intestinal alkaline phosphatase [16]. …”

Section: Discussionmentioning

confidence: 99%

Comparison of hypertonic saline versus normal saline on cytokine profile during CABG

et al. 2012

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Background and the purpose of the studyBlood contact with artificial surfaces of the extracorporeal circuit and ischemia-reperfusion injury in CABG with CPB, may lead to a systemic inflammatory response. Hypertonic saline have been recently investigated as a fluid in order to decrease inflammatory response and cytokines generation in patients undergo cardiac operations. Our purpose is to study the prophylactic effect of HS 5% infusion versus NS on serum IL-6 as an inflammatory & IL-10 as an anti-inflammatory biomarker in CABG patients.MethodsThe present study is a randomized double-blinded clinical trial. 40 patients undergoing CABG were randomized to receive HS 5% or NS before operation. Blood samples were obtained after receiving HS or NS, just before operation, 24 and 48 hours post-operatively. Plasma levels of IL-6 and IL-10 were measured by ELISA.Results and major conclusionPatients received HS had lower levels of IL-6 and higher level of IL-10 compared with NS group, however these differences were not statistically significant. Results of this study suggest that pre-treatment with small volume hypertonic saline 5% may have beneficial effects on inflammatory response following CABG operation.

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The intraoperative effect of pentoxifylline on the inflammatory process and leukocytes in cardiac surgery patients undergoing cardiopulmonary bypass

Abstract: CPB-related whole body inflammatory response could be partially inhibited by intraoperative PTX administration. This effect of PTX would be helpful in preventing the well-known complications of CPB-induced systemic inflammation.

Cited by 23 publications

References 28 publications

Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin

Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin

Pentoxifylline for vascular health: a brief review of the literature

Comparison of hypertonic saline versus normal saline on cytokine profile during CABG

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