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Pfeilschifter W, Steinstraesser T, Paulus P, Zeiner PS, Bohmann F, Theisen A, Lindhoff-Last E, Penski C, Wagner M, Mittelbronn M, Foerch C. Risk of long-term anticoagulation under sustained severe arterial hypertension: A translational study comparing warfarin and the new oral anticoagulant apixaban. J Cereb Blood Flow Metab 2017; 37:855-865. [PMID: 27189904 PMCID: PMC5363464 DOI: 10.1177/0271678x16642443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
New oral anticoagulants for the prevention of stroke and systemic embolism in patients with atrial fibrillation have recently been introduced. In this translational study, we explored the risk of long-term anticoagulation on intracerebral hemorrhage under sustained severe arterial hypertension. We initiated anticoagulation with warfarin or apixaban in spontaneously hypertensive rats prone to develop severe hypertension and subsequent intracerebral bleeding complications. A non-anticoagulated group served as control. During an 11-week-study period, blood pressure, anticoagulation parameters, and clinical status were determined regularly. The incidence of histopathologically proven intracerebral hemorrhage was defined as the primary endpoint. Both warfarin and apixaban anticoagulation was fairly stable during the study period, and all rats developed severe hypertension. Intracerebral hemorrhage was determined in 29% (4/14) of warfarin rats and in 10% (1/10) of apixaban rats. Controls did not show cerebral bleeding complications (chi-square not significant). Mortality rate at study termination was 33% (2/6) in controls, 43% (6/14) in the warfarin group, and 60% (6/10) in the apixaban group. Animals died from extracerebral complications in most cases. Our study describes an experimental intracerebral hemorrhage model in the context of sustained hypertension and long-term anticoagulation. Extracerebral bleeding complications occurred more often in warfarin-treated animals compared with apixaban and control rats.
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Affiliation(s)
| | | | - Patrick Paulus
- 2 Department of Anesthesiology and Operative Intensive Care Medicine, Kepler University Hospital, Linz, Austria
| | - Pia Susan Zeiner
- 1 Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Ferdinand Bohmann
- 1 Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Alf Theisen
- 3 Zentrale Forschungseinheit, Goethe-University, Frankfurt am Main, Germany
| | - Edelgard Lindhoff-Last
- 4 Department of Internal Medicine, Goethe-University, Frankfurt am Main, Germany.,5 CCB Coagulation Research Center, Bethanien Hospital, Frankfurt am Main, Germany
| | - Cornelia Penski
- 6 Neurological Institute (Edinger Institute), Goethe-University, Frankfurt am Main, Germany
| | - Marlies Wagner
- 7 Institute of Neuroradiology, Goethe-University, Frankfurt am Main, Germany
| | - Michel Mittelbronn
- 6 Neurological Institute (Edinger Institute), Goethe-University, Frankfurt am Main, Germany
| | - Christian Foerch
- 1 Department of Neurology, Goethe-University, Frankfurt am Main, Germany
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2
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Ghiasi S, Ghiasi S, Abdollahi M. A Review on the Potential Benefits of Phosphodiesterase Inhibitors in Various Models of Toxicities in Animals. ACTA ACUST UNITED AC 2012. [DOI: 10.3923/ajava.2012.210.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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3
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Sabry A, El-Husseini A, Sheashaa H, Abdel-Shafy E, El-Dahshan K, Abdel-Rahim M, Abdel-Kaleek E, Abo-Zena H. Colchicine vs. Omega-3 Fatty Acids for Prevention of Chronic Cyclosporine Nephrotoxicity in Sprague Dawley Rats: An Experimental Animal Model. Arch Med Res 2006; 37:933-40. [DOI: 10.1016/j.arcmed.2006.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 07/03/2006] [Indexed: 12/01/2022]
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4
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Abstract
Nearly 50 medications have been implicated as inducing hypomagnesaemia, sometimes based on insufficient data regarding clinical significance and frequency of occurrence. In fact, clinical effects attributed to hypomagnaesemia have been reported in only 17 of these drugs. A considerable amount of literature relating to individual drugs has been published, yet a comprehensive overview of this issue is not available and the hypomagnesaemic effect of a drug could be either overemphasised or under-rated. In addition, there are neither guidelines regarding treatment, prevention and monitoring of drug-induced hypomagnesaemia nor agreement as to what serum level of magnesium may actually be defined as 'hypomagnesaemia'. By compiling data from published papers, electronic databases, textbooks and product information leaflets, we attempted to assess the clinical significance of hypomagnesaemia induced by each drug. A practical approach for managing drug-induced hypomagnesaemia, incorporating both published literature and personal experience of the physician, is proposed. When drugs classified as inducing 'significant' hypomagnesaemia (cisplatin, amphotericin B, ciclosporin) are administered, routine magnesium monitoring is warranted, preventive treatment should be considered and treatment of hypomagnesaemia should be initiated with or without overt clinical manifestations. In drugs belonging to the 'potentially significant' category, among which are amikacin, gentamicin, laxatives, pentamidine, tobramycin, tacrolimus and carboplatin, magnesium monitoring is justified when either of the following occurs: clinical manifestations are apparent; persistent hypokalaemia, hypocalcaemia or alkalosis are present; other precipitating factors for hypomagnesaemia coexist; or treatment is with more than one potentially hypomagnesaemic drug. No preventive treatment is required and treatment should be initiated only if hypomagnesaemia is accompanied by symptoms or clinically significant relevant laboratory findings. In those drugs whose hypomagnesaemic effect is labelled as 'questionable', including furosemide and hydrochlorothiazide, routine monitoring and treatment are not required.
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Affiliation(s)
- Jacob Atsmon
- Clinical Pharmacology Unit, Tel Aviv Sourasky Medical Center, Te Aviv, Israel.
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5
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Affiliation(s)
- Leendert C Paul
- Department of Nephrology, Leiden University Medical Center, The Netherlands
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6
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Miura K, Nakatani T, Asai T, Yamanaka S, Tamada S, Tashiro K, Kim S, Okamura M, Iwao H. Role of hypomagnesemia in chronic cyclosporine nephropathy. Transplantation 2002; 73:340-7. [PMID: 11884928 DOI: 10.1097/00007890-200202150-00005] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hypomagnesemia is a common finding of cyclosporine (CsA)-treated patients and has been proposed as both a cause and a consequence of CsA-induced nephrotoxicity. This experiment was conducted to elucidate the role of hypomagnesemia in the pathogenesis of chronic CsA nephropathy. METHODS CsA (15 mg/kg/day subcutaneously) was administered to rats maintained on a low-sodium diet for 1, 2, and 4 weeks, and the effects of magnesium (Mg) supplementation on renal function, renal histology, and renal gene expression profile of fibrogenic molecules and vasoconstrictors was examined. RESULTS CsA elicited hypomagnesemia and induced a progressive decline in glomerular filtration. At 28 day, renal tubular atrophy and cortical striped interstitial fibrosis were evident with CsA treatment. Dietary supplementation of Mg ameliorated CsA-induced hypomagnesemia and almost completely abolished CsA-induced chronic fibrotic lesions. Neither CsA nor Mg supplementation affected blood pressure. Renal cortical mRNA of transforming growth factor beta, plasminogen activator inhibitor (PAI)-1, and extracellular matrix started to increase at 14 days and elevated further at 28 days. In contrast, the increase in mRNA of tissue inhibitor of matrix metalloproteinase-1 and renin was evident early at 7 days and reached peak at 14 days. These mRNA increases, except that of renin, were almost abolished when hypomagnesemia was corrected. Magnesium supplementation also improved glomerular dysfunction, at least in part, through inhibition of up-regulated mRNA of endothelin-1. CONCLUSION CsA-induced hypomagnesemia contributes to chronic renal fibrotic lesions seen during CsA treatment through up-regulation of fibrogenic molecules, most notably early activation of tissue inhibitor of matrix metalloproteinase-1 expression.
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Affiliation(s)
- Katsuyuki Miura
- Department of Pharmacology, Osaka City University Medical School, Abeno, Osaka, Japan
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7
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Abstract
Organ transplantation has become a common and effective approach to the management of patients with organ failure. The improvement in long-term survival has resulted in the emergence of cardiovascular disease as the primary cause of death in renal transplant patients and a significant complication in other organ recipients. A number of factors explain this trend, including a high incidence of hypertension, posttransplant diabetes, hyperlipidemia, and obesity-risk factors that are mediated by direct effects of immunosuppressive medications. Weight gain posttransplant affects approximately 50% of patients and represents a significant problem because of the potential synergism between obesity and immunosuppressive medication-induced effects on cardiovascular disease risk factor development. This review discusses the incidence and implications of cardiovascular disease risk factors in organ transplant recipients, strategies for clinical management, and future research directions.
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Affiliation(s)
- C L Baum
- Department of Medicine, University of Illinois at Chicago, 60612, USA.
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8
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Abstract
Increasing numbers of individuals leading normal lives have transplanted organs. They may appear in any hospital for treatment of trauma or general diseases. Common anaesthesia methods can be used for these patients, but safe conduct of anaesthesia requires knowledge of the immunosuppression, risk factors, and altered physiology or drug actions. This article reviews the anaesthesia-related literature on patients with transplanted organs.
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Affiliation(s)
- H J Toivonen
- Department of Anaesthesia, University of Helsinki, Finland.
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9
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Pere AK, Krogerus L, Mervaala EM, Karppanen H, Ahonen J, Lindgren L. Beneficial effects of dietary magnesium and potassium on cardiac and renal morphologic features in cyclosporin A-induced damage in spontaneously hypertensive rats. Surgery 2000; 128:67-75. [PMID: 10876188 DOI: 10.1067/msy.2000.106530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cyclosporin A-induced hypertension is dependent on the level of dietary salt. We investigated whether dietary magnesium or potassium could protect against cyclosporin A-induced cardiac and renal damage in spontaneously hypertensive rats (SHRs) on high-sodium diet. METHODS Eight-week-old SHRs were divided into 4 groups: (1) receiving a high-sodium diet, (2) receiving a high-sodium, high-potassium diet, (3) receiving a high-sodium, high-magnesium diet, and (4) receiving a high-sodium, high-potassium, high-magnesium diet. The effects of cyclosporin A in SHRs on a relatively low-sodium diet and in normotensive Wistar-Kyoto rats were also examined. Cardiac and renal morphologic condition was assessed, and tissue damage was scored by light microscopy after 6 weeks of cyclosporin A treatment. RESULTS In SHRs on a high-sodium diet, cyclosporin A caused luminal narrowing of the coronary arteries, left ventricular scarring, and damage in the renal arterioli and glomeruli. Dietary magnesium supplementation alone and in combination with potassium protected against these changes, whereas potassium alone was less effective. Cyclosporin A treatment caused only minor histopathologic changes in SHRs receiving a low-sodium diet. Interestingly, the detrimental interaction between cyclosporin A and a high-sodium diet was also observed in normotensive Wistar-Kyoto rats. CONCLUSIONS Dietary magnesium, especially in combination with potassium, protects against cyclosporin A-induced cardiac and renal damage.
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Affiliation(s)
- A K Pere
- Division of Transplantation Surgery, Fourth Department of Surgery, Helsinki University Central Hospital, Finland
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10
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Lassila M, Finckenberg P, Pere AK, Krogerus L, Ahonen J, Vapaatalo H, Nurminen ML. Comparison of enalapril and valsartan in cyclosporine A-induced hypertension and nephrotoxicity in spontaneously hypertensive rats on high-sodium diet. Br J Pharmacol 2000; 130:1339-47. [PMID: 10903974 PMCID: PMC1572182 DOI: 10.1038/sj.bjp.0703422] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2000] [Revised: 03/24/2000] [Accepted: 04/10/2000] [Indexed: 11/09/2022] Open
Abstract
1. We compared the effects of the angiotensin converting enzyme (ACE) inhibitor enalapril and the angiotensin AT(1) receptor antagonist valsartan in cyclosporine A (CsA)-induced hypertension and nephrotoxicity in spontaneously hypertensive rats (SHR). 2. SHR (8 - 9 weeks old) on high-sodium diet were given CsA (5 mg kg(-1)d (-1) s.c. ) for 6 weeks. The rats were treated concomitantly either with enalapril (30 mg kg(-1)d (-1) p.o.) or valsartan (3 or 30 mg kg(-1) d (-1) p.o.). To evaluate the role of bradykinin in the action of enalapril, some rats received a bradykinin B(2) receptor antagonist icatibant (HOE 140, 500 microg kg(-1) d (-1) s.c.) during the last 2 weeks of enalapril treatment. 3. Blood pressure was recorded every second week by tail cuff method. Renal function was measured by serum creatinine, creatinine clearance and urinary excretion of proteins at the end of the experiment. The activity of the renal kallikrein-kinin system was estimated by urinary kallikrein excretion. 4. CsA caused hypertension, impaired renal function and induced morphological nephrotoxicity with glomerular damage and interstitial fibrosis. Enalapril and the lower dose of valsartan attenuated the CsA-induced hypertension to the same extent, while the higher dose of valsartan totally abolished it. Icatibant did not reduce the antihypertensive effect of enalapril. Urinary kallikrein excretion was similar in all groups. 5. Enalapril and valsartan equally prevented the CsA-induced deterioration of kidney function and morphology. 6. The renin-angiotensin but not the kallikrein-kinin system plays a crucial role in CsA-toxicity during high intake of sodium in SHR.
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MESH Headings
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors/pharmacology
- Animals
- Antihypertensive Agents/pharmacology
- Blood Pressure/drug effects
- Body Weight/drug effects
- Bradykinin/analogs & derivatives
- Bradykinin/pharmacology
- Bradykinin Receptor Antagonists
- Cyclosporine/adverse effects
- Dose-Response Relationship, Drug
- Drinking/drug effects
- Eating/drug effects
- Electrolytes/urine
- Enalapril/pharmacology
- Heart Rate/drug effects
- Hypertension/chemically induced
- Hypertension/physiopathology
- Hypertension/prevention & control
- Hypertrophy, Left Ventricular/chemically induced
- Hypertrophy, Left Ventricular/prevention & control
- Kallikreins/drug effects
- Kallikreins/urine
- Kidney/drug effects
- Kidney/pathology
- Kidney/physiopathology
- Kidney Diseases/chemically induced
- Kidney Diseases/physiopathology
- Kidney Diseases/prevention & control
- Male
- Rats
- Rats, Inbred SHR
- Receptor, Angiotensin, Type 1
- Receptor, Angiotensin, Type 2
- Receptor, Bradykinin B2
- Renin/blood
- Renin/drug effects
- Sodium, Dietary/administration & dosage
- Tetrazoles/pharmacology
- Urination/drug effects
- Valine/analogs & derivatives
- Valine/pharmacology
- Valsartan
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Affiliation(s)
- Markus Lassila
- Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Helsinki, Finland
| | - Piet Finckenberg
- Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Helsinki, Finland
| | - Anna-Kaisa Pere
- Research Laboratory, Fourth Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Leena Krogerus
- Department of Pathology, Helsinki City Hospital, Helsinki, Finland
| | - Juhani Ahonen
- Research Laboratory, Fourth Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Heikki Vapaatalo
- Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Helsinki, Finland
| | - Marja-Leena Nurminen
- Institute of Biomedicine, Department of Pharmacology and Toxicology, University of Helsinki, Finland
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11
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Lassila M, Finckenberg P, Pere AK, Vapaatalo H, Nurminen ML. Enalapril and valsartan improve cyclosporine A-induced vascular dysfunction in spontaneously hypertensive rats. Eur J Pharmacol 2000; 398:99-106. [PMID: 10856453 DOI: 10.1016/s0014-2999(00)00282-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cyclosporine A causes hypertension and nephrotoxicity in spontaneously hypertensive rats (SHR). In the present study, arterial function was investigated using in vitro vascular preparations after long-term treatment with cyclosporine A. SHR received cyclosporine A (5 mg kg(-1) day(-1) s.c.) and high-Na(+) diet for 6 weeks during the developmental phase of hypertension. Part of the rats were treated concomitantly either with the angiotensin converting enzyme inhibitor enalapril (30 mg kg(-1) day(-1) p.o.) or with an angiotensin AT(1) receptor antagonist valsartan (3 or 30 mg kg(-1) day(-1) p.o.). In renal arteries, contractile responses to noradrenaline and angiotensin II, as well as relaxation responses to acetylcholine (endothelium-dependent) and to sodium nitroprusside (endothelium-independent), were severely impaired by cyclosporine A-treatment. There was also a trend for the dysfunction of the mesenteric arteries, but the impairment did not reach statistical difference. Enalapril and valsartan improved the impaired renal arterial functions. Cyclosporine A-induced hypertension and nephrotoxicity seem to be associated with renal arterial dysfunction in SHR on high-Na(+) diet. Antagonism of the renin-angiotensin system protects from vascular toxicity of cyclosporine A.
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Affiliation(s)
- M Lassila
- Department of Pharmacology and Toxicology, Institute of Biomedicine, University of Helsinki, P.O. Box 8, FIN-00014, Helsinki, Finland
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