Wednesday, June 18, 2008

Wednesday June 18, 2008
Another use of Flolan !


Flolan (Epoprostenol sodium) is a common IV infusion used for pulmonary hypertension. Another less known use of Flolan is in Cardiac bypass surgery for patients already known (pre-operatively) to have HIT type II (type II heparin-induced thrombocytopenia ).

Epoprostenol sodium, a prostaglandin (PGI2), vasodilator, used in patients with pulmonary hypertension, is also a potent platelet inhibitor. Epoprostenol sodium is successfully used in association with heparin in patients with type II HIT requiring anticoagulation for hemodialysis, or vascular or cardiac surgery.

Overall results seems effective and safe with acceptable postoperative blood losses. On cautious side, epoprostenol sodium may induce hypotension and may require use of a vasoconstrictor like norepinephrine.


Protocol: One recommended protocol is continuous infusion of epoprostenol sodium started after induction of anesthesia at a rate of 5 ng/kg/min, infusion rate increased by stages of 5 µg/kg every 5 minutes, and when the infusion rate reached 30 ng/kg/min, a bolus of 300 U/kg of heparin was intravenously administered. When required, norepinephrine (0.05 to 0.1 µg/kg/min) was infused to maintain mean arterial pressure greater than 75 mmHg. CPB was started when ACT exceeded 480 seconds. After emergence from CPB, heparin was reversed with protamine (3 mg/kg). Fifteen minutes after protamine reversal, epoprostenol sodium infusion was reduced by stages of 5 ng/kg until stopped.



Reference : click to get abstract

1.
Cardiac surgery with cardiopulmonary bypass in patients with type II heparin-induced thrombocytopenia Ann Thorac Surg 2001;71:678-683