Treprostinil is a relatively new tricyclic prostacyclin analog with a stable str-ucture,extended half-life and improved potency.Currently,treprostinil is indicated by the Food and Drug Administration in the United Sta...Treprostinil is a relatively new tricyclic prostacyclin analog with a stable str-ucture,extended half-life and improved potency.Currently,treprostinil is indicated by the Food and Drug Administration in the United States for the treatment of pulmonary arterial hypertension(group 1 in the pulmonary hy-pertension classification of the World Health Organization).It has a potent vasodilating effect along with the inhibition of platelet aggregation and the attenuation of the inflammatory response in pulmonary and systemic circulation.It is available in the following formulations:Subcutaneous,intravenous,inhaled and oral.Although unknown to many clinicians,several encouraging reports of off-label treprostinil use in the adult population suggest its potential effectiveness in other clinical conditions.Currently under investigation are digital ischemia secondary to systemic sclerosis,chronic limb ischemia,hepatic ischemia-reper-fusion injury and group 3 and 4 pulmonary hypertension.Based on review and analysis of the available literature,this article provides a thorough update on the off-label use of treprostinil in adult patients.展开更多
Objective:Pulmonary hypertension is a crucial factor affecting the recovery after Glenn procedure.This study explores the effects of intravenous treprostinil on hemodynamic status and hospital postoperative recovery u...Objective:Pulmonary hypertension is a crucial factor affecting the recovery after Glenn procedure.This study explores the effects of intravenous treprostinil on hemodynamic status and hospital postoperative recovery under different administration strategies.Methods:We retrospectively included pediatric patients admitted to Fuwai Hospital from 2019 to 2022 who underwent the Glenn procedure and had intraoperative measurements of mean pulmonary artery pressure(mPAP)>15 mmHg postoperatively.Patients with non-anatomical single ventricle physiology undergoing the Glenn procedure and those requiring postoperative extracorporeal membrane oxygenation were excluded.Due to the standardized use of treprostinil in our center starting in 2021,patients from 2019–2020 were included in Group 1,and patients from 2021–2022 were included in Group 2.The changes in hemodynamic data before and after medication for both groups of patients,as well as the differences in postoperative recovery,were compared.Results:Twenty-eight patients were eventually enrolled in the study.Group 1 consisted of 14 cases,with a maintenance dose of 11±2 ng/(kg·min)1 to 2 days postoperatively.Group 2 also consisted of 14 cases,with a maintenance dose of 26±7 ng/(kg·min)1 day postoperatively.After a 24-h observation period,the mPAP decreased from 17±3 to 13±3 mmHg(p<0.001)in the first group and decreased from 18±3 to 13±3 mmHg(p<0.001)in the second group.The vasoactive-inotropic score in the first group decreased from 9(6,17)to 6(4,9)(p=0.001)and decreased from 12(6,23)to 10(3,15)(p=0.002)in the second group.Group 2 patients had a shorter postoperative hospital stay than Group 1,with durations of 18(11,22)days and 29(19,47)days,respectively(p=0.021).No severe adverse reactions occurred in all patients.Conclusion:Intravenous infusion of treprostinil in high-risk patients after the Glenn procedure can decrease pulmonary artery pressure,reduce vasoactive-inotropic score,and demonstrate satisfactory drug tolerance without severe adverse reactions.Standardized use of treprostinil facilitates postoperative recovery and shortens postoperative length of stay.展开更多
Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections...Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections and liver transplantation.In addition to the organ’s post reperfusion injury,this syndrome appears to play a central role in the dysfunction of distant tissues and systems.Thus,continuous research should be directed toward finding effective therapeutic options to improve the outcome and reduce the postoperative morbidity and mortality rates.Treprostinil is a synthetic analog of prostaglandin I2,and its experimental administration has shown encouraging results.It has already been approved by the Food and Drug Administration in the United States for pulmonary arterial hypertension and has been used in liver transplantation,where preliminary encouraging results showed its safety and feasibility by using continuous intravenous administration at a dose of 5 ng/kg/min.Treprostinil improves renal and hepatic function,diminishes hepatic oxidative stress and lipid peroxidation,reduces hepatictoll-like receptor 9 and inflammation,inhibits hepatic apoptosis and restores hepatic adenosine triphosphate(ATP)levels and ATP synthases,which is necessary for functional maintenance of mitochondria.Treprostinil exhibits vasodilatory properties and antiplatelet activity and regulates proinflam-matory cytokines;therefore,it can potentially minimize ischemia-reperfusion injury.Additionally,it may have beneficial effects on cardiovascular parameters,and much current research interest is concentrated on this compound.展开更多
文摘Treprostinil is a relatively new tricyclic prostacyclin analog with a stable str-ucture,extended half-life and improved potency.Currently,treprostinil is indicated by the Food and Drug Administration in the United States for the treatment of pulmonary arterial hypertension(group 1 in the pulmonary hy-pertension classification of the World Health Organization).It has a potent vasodilating effect along with the inhibition of platelet aggregation and the attenuation of the inflammatory response in pulmonary and systemic circulation.It is available in the following formulations:Subcutaneous,intravenous,inhaled and oral.Although unknown to many clinicians,several encouraging reports of off-label treprostinil use in the adult population suggest its potential effectiveness in other clinical conditions.Currently under investigation are digital ischemia secondary to systemic sclerosis,chronic limb ischemia,hepatic ischemia-reper-fusion injury and group 3 and 4 pulmonary hypertension.Based on review and analysis of the available literature,this article provides a thorough update on the off-label use of treprostinil in adult patients.
基金supported by the Clinical Research Foundation of the National Health Commission of the People’s Republic of China(grant numbers:2022-GSP-GG-32,2022-GSP-QN-13 and 2023-GSP-QN-5).
文摘Objective:Pulmonary hypertension is a crucial factor affecting the recovery after Glenn procedure.This study explores the effects of intravenous treprostinil on hemodynamic status and hospital postoperative recovery under different administration strategies.Methods:We retrospectively included pediatric patients admitted to Fuwai Hospital from 2019 to 2022 who underwent the Glenn procedure and had intraoperative measurements of mean pulmonary artery pressure(mPAP)>15 mmHg postoperatively.Patients with non-anatomical single ventricle physiology undergoing the Glenn procedure and those requiring postoperative extracorporeal membrane oxygenation were excluded.Due to the standardized use of treprostinil in our center starting in 2021,patients from 2019–2020 were included in Group 1,and patients from 2021–2022 were included in Group 2.The changes in hemodynamic data before and after medication for both groups of patients,as well as the differences in postoperative recovery,were compared.Results:Twenty-eight patients were eventually enrolled in the study.Group 1 consisted of 14 cases,with a maintenance dose of 11±2 ng/(kg·min)1 to 2 days postoperatively.Group 2 also consisted of 14 cases,with a maintenance dose of 26±7 ng/(kg·min)1 day postoperatively.After a 24-h observation period,the mPAP decreased from 17±3 to 13±3 mmHg(p<0.001)in the first group and decreased from 18±3 to 13±3 mmHg(p<0.001)in the second group.The vasoactive-inotropic score in the first group decreased from 9(6,17)to 6(4,9)(p=0.001)and decreased from 12(6,23)to 10(3,15)(p=0.002)in the second group.Group 2 patients had a shorter postoperative hospital stay than Group 1,with durations of 18(11,22)days and 29(19,47)days,respectively(p=0.021).No severe adverse reactions occurred in all patients.Conclusion:Intravenous infusion of treprostinil in high-risk patients after the Glenn procedure can decrease pulmonary artery pressure,reduce vasoactive-inotropic score,and demonstrate satisfactory drug tolerance without severe adverse reactions.Standardized use of treprostinil facilitates postoperative recovery and shortens postoperative length of stay.
文摘Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections and liver transplantation.In addition to the organ’s post reperfusion injury,this syndrome appears to play a central role in the dysfunction of distant tissues and systems.Thus,continuous research should be directed toward finding effective therapeutic options to improve the outcome and reduce the postoperative morbidity and mortality rates.Treprostinil is a synthetic analog of prostaglandin I2,and its experimental administration has shown encouraging results.It has already been approved by the Food and Drug Administration in the United States for pulmonary arterial hypertension and has been used in liver transplantation,where preliminary encouraging results showed its safety and feasibility by using continuous intravenous administration at a dose of 5 ng/kg/min.Treprostinil improves renal and hepatic function,diminishes hepatic oxidative stress and lipid peroxidation,reduces hepatictoll-like receptor 9 and inflammation,inhibits hepatic apoptosis and restores hepatic adenosine triphosphate(ATP)levels and ATP synthases,which is necessary for functional maintenance of mitochondria.Treprostinil exhibits vasodilatory properties and antiplatelet activity and regulates proinflam-matory cytokines;therefore,it can potentially minimize ischemia-reperfusion injury.Additionally,it may have beneficial effects on cardiovascular parameters,and much current research interest is concentrated on this compound.
