In the Journals

Low-dose olprinone reduces risk for atrial fibrillation after lung cancer surgery

The administration of olprinone continuously during lung cancer surgery reduced the risk for atrial fibrillation in patients with elevated preoperative B-type natriuretic peptide levels, according to study results.

“Continuous infusion of low-dose olprinone was found to be highly tolerable, and no significant adverse effects were observed,” Takashi Nojiri, MD, PhD, a general thoracic surgery staff surgeon at Osaka University Graduate School of Medicine in Japan, and colleagues wrote. “These findings indicate that low-dose olprinone is a preferred treatment option to prevent postoperative atrial fibrillation in high-risk patients undergoing non-cardiac surgery.”

Takashi Nojiri

Takashi Nojiri

Phosphodiesterase (PDE) type III is present in the myocardium, vascular smooth muscle, alveolar macrophages, bronchial smooth muscle and platelets. Consequently, PDE-III inhibitors have been considered a potential treatment for patients with cardiac disease (eg, acute heart failure) and pulmonary disease (eg, bronchial asthma or pulmonary hypertension) due to their inotropic, vasodilating, and bronchodilator effects, Nojiri told HemOnc Today.

Olprinone, a specific PDE-III inhibitor, has been used clinically for the treatment of acute heart failure in Japan.

“It [has been] reported to stabilize hemodynamic parameters without affecting heart rate or blood pressures at low doses, and [has shown] significant anti-inflammatory effects,” Nojiri told HemOnc Today. “We hypothesized that low-dose olprinone could have the beneficial effects on lung cancer surgery.”

Nojiri and colleagues conducted a prospective, randomized, double blind, placebo-controlled, parallel-group study to assess whether olprinone could reduce the risk for atrial fibrillation in patients with elevated preoperative B-type natriuretic peptide (BNP) levels who underwent lung cancer surgery.

The analysis included 40 patients. Twenty patients received low-dose olprinone (0.1 µg/kg/minute) and the other 20 patients received 0.9% saline for 24 hours.

Twelve patients who received saline and two patients who received olprinone developed postoperative atrial fibrillation (P = .0005).

No deaths following surgery, no thromboembolic events and no acute heart failure associated with atrial fibrillation occurred in either group.

Patients assigned olprinone had lower levels of BNP on days 1 (P < .05), 3 (P < .001) and 7 (P < .05) following surgery.

Patients assigned olprinone also had lower white blood cell counts and C-reactive protein levels on days 3 and 7 after surgery (P < .05 for both).

Additional research is needed to observe outcomes in a larger number of patients over a longer period, according to the researchers.

“A larger, multicenter study is necessary to validate and generalize the findings of the present study,” the researchers wrote. “Furthermore, echocardiographic and cardiac catheter examinations were not performed following surgery in the present study, and there are no data regarding any beneficial effects on invasive hemodynamic parameters during the perioperative period.” – by Ryan McDonald

For more information:

Takashi Nojiri, MD, PhD, can be reached at nojirit@thoracic.med.osaka-u.ac.jp.

Disclosure: The researchers report no relevant financial disclosures.

The administration of olprinone continuously during lung cancer surgery reduced the risk for atrial fibrillation in patients with elevated preoperative B-type natriuretic peptide levels, according to study results.

“Continuous infusion of low-dose olprinone was found to be highly tolerable, and no significant adverse effects were observed,” Takashi Nojiri, MD, PhD, a general thoracic surgery staff surgeon at Osaka University Graduate School of Medicine in Japan, and colleagues wrote. “These findings indicate that low-dose olprinone is a preferred treatment option to prevent postoperative atrial fibrillation in high-risk patients undergoing non-cardiac surgery.”

Takashi Nojiri

Takashi Nojiri

Phosphodiesterase (PDE) type III is present in the myocardium, vascular smooth muscle, alveolar macrophages, bronchial smooth muscle and platelets. Consequently, PDE-III inhibitors have been considered a potential treatment for patients with cardiac disease (eg, acute heart failure) and pulmonary disease (eg, bronchial asthma or pulmonary hypertension) due to their inotropic, vasodilating, and bronchodilator effects, Nojiri told HemOnc Today.

Olprinone, a specific PDE-III inhibitor, has been used clinically for the treatment of acute heart failure in Japan.

“It [has been] reported to stabilize hemodynamic parameters without affecting heart rate or blood pressures at low doses, and [has shown] significant anti-inflammatory effects,” Nojiri told HemOnc Today. “We hypothesized that low-dose olprinone could have the beneficial effects on lung cancer surgery.”

Nojiri and colleagues conducted a prospective, randomized, double blind, placebo-controlled, parallel-group study to assess whether olprinone could reduce the risk for atrial fibrillation in patients with elevated preoperative B-type natriuretic peptide (BNP) levels who underwent lung cancer surgery.

The analysis included 40 patients. Twenty patients received low-dose olprinone (0.1 µg/kg/minute) and the other 20 patients received 0.9% saline for 24 hours.

Twelve patients who received saline and two patients who received olprinone developed postoperative atrial fibrillation (P = .0005).

No deaths following surgery, no thromboembolic events and no acute heart failure associated with atrial fibrillation occurred in either group.

Patients assigned olprinone had lower levels of BNP on days 1 (P < .05), 3 (P < .001) and 7 (P < .05) following surgery.

Patients assigned olprinone also had lower white blood cell counts and C-reactive protein levels on days 3 and 7 after surgery (P < .05 for both).

Additional research is needed to observe outcomes in a larger number of patients over a longer period, according to the researchers.

“A larger, multicenter study is necessary to validate and generalize the findings of the present study,” the researchers wrote. “Furthermore, echocardiographic and cardiac catheter examinations were not performed following surgery in the present study, and there are no data regarding any beneficial effects on invasive hemodynamic parameters during the perioperative period.” – by Ryan McDonald

For more information:

Takashi Nojiri, MD, PhD, can be reached at nojirit@thoracic.med.osaka-u.ac.jp.

Disclosure: The researchers report no relevant financial disclosures.