Impact of Perioperative Levosimendan Administration on Risk of Bleeding After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials
Background Levosimendan, a calcium sensitizer and potassium channel opener, has been demonstrated to improve myocardial function without increasing oxygen consumption and to show protective effects in other organs. Recently, a prospective, randomized controlled trial (RCT) revealed an association be...
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| Veröffentlicht in: | American journal of cardiovascular drugs : drugs, devices, and other interventions devices, and other interventions, 2020-04, Vol.20 (2), p.149-160 |
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| creator | Yan, Sen-bo Wang, Xiao-yan Shang, Guo-kai Wang, Zhi-hao Deng, Qi-ming Song, Jia-wen Sai, Wen-wen Song, Ming Zhong, Ming Zhang, Wei |
| description | Background
Levosimendan, a calcium sensitizer and potassium channel opener, has been demonstrated to improve myocardial function without increasing oxygen consumption and to show protective effects in other organs. Recently, a prospective, randomized controlled trial (RCT) revealed an association between levosimendan use and a possible increased risk of bleeding postoperatively. Levosimendan’s anti-platelet effects have been shown in in vitro studies. Current studies do not provide sufficient data to support a relation between perioperative levosimendan administration and increased bleeding risk.
Purpose
Our goal was to investigate the relation between perioperative levosimendan administration and increased bleeding risk using a meta-analysis study design.
Methods
The PubMed, Ovid, EMBASE and Cochrane Library databases were searched for relevant RCTs before July 1, 2019. The outcome parameters included reoperation secondary to increased bleeding in the postoperative period, the amount of postoperative recorded blood loss, and the need for transfusion of packed red blood cells (RBCs) and other blood products.
Results
A total of 1160 patients in nine RCTs (576 in the levosimendan group and 584 in the control group) were included according to our inclusion criteria. Analysis showed that perioperative levosimendan administration neither increased the rate of reoperation secondary to bleeding nor increased the amount of postoperative chest tube drainage when compared with the control group. In terms of blood product transfusion, levosimendan did not influence the requirement for RBC transfusion, platelet transfusion nor fresh frozen plasma (FFP) transfusion. Levosimendan also did not shorten or prolong the aortic cross-clamp time or the cardiopulmonary bypass time.
Conclusion
The analyzed parameters, including reoperations due to bleeding, postoperative chest drainage and the requirement for blood products, revealed that levosimendan did not increase postoperative bleeding risk. More studies with a larger sample size are needed to address a more reliable conclusion due to study limitations. |
| doi_str_mv | 10.1007/s40256-019-00372-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2384583139</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2384583139</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-5e335e1255c8216ca065fc934f66b22d044321f4806736c0a7a79e3c682731ff3</originalsourceid><addsrcrecordid>eNp9UdFqFDEUDaLYuvoDPkjA52iSO0lmfFuXqoUtlVrBtyHN3JTUmWRNZgvbj_Cbm-1WfRMunAv3nHMv9xDyWvB3gnPzvjRcKs246BjnYCSTT8ixEKZjojU_nj70ioE05oi8KOWGc2Gk6Z6TIxBKgtH8mPw-nTbWzTR5-hVzSBvMdg63SNd4m0qYMA420uUwhRjKvJ-lSGtdhPJzL_o4Ig4hXtOlnzHTlc1DsI5-2-ZrzLsPdEnPcLbMRjvuSih7yYWNQ5rCHQ50leKc0zjW9jIHO5aX5JmvgK8ecUG-fzq5XH1h6_PPp6vlmjkwamYKARQKqZRrpdDOcq2866DxWl9JOfCmASl803JtQDtujTUdgtOtNCC8hwV5e_Dd5PRri2Xub9I21yNLL6FtVAsCusqSB5bLqZSMvt_kMNm86wXv9xH0hwj6GkH_EEFVL8ibR-vt1YTDX8mfn1cCHAiljmJ907_d_7G9B9BQkfU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2384583139</pqid></control><display><type>article</type><title>Impact of Perioperative Levosimendan Administration on Risk of Bleeding After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Yan, Sen-bo ; Wang, Xiao-yan ; Shang, Guo-kai ; Wang, Zhi-hao ; Deng, Qi-ming ; Song, Jia-wen ; Sai, Wen-wen ; Song, Ming ; Zhong, Ming ; Zhang, Wei</creator><creatorcontrib>Yan, Sen-bo ; Wang, Xiao-yan ; Shang, Guo-kai ; Wang, Zhi-hao ; Deng, Qi-ming ; Song, Jia-wen ; Sai, Wen-wen ; Song, Ming ; Zhong, Ming ; Zhang, Wei</creatorcontrib><description>Background
Levosimendan, a calcium sensitizer and potassium channel opener, has been demonstrated to improve myocardial function without increasing oxygen consumption and to show protective effects in other organs. Recently, a prospective, randomized controlled trial (RCT) revealed an association between levosimendan use and a possible increased risk of bleeding postoperatively. Levosimendan’s anti-platelet effects have been shown in in vitro studies. Current studies do not provide sufficient data to support a relation between perioperative levosimendan administration and increased bleeding risk.
Purpose
Our goal was to investigate the relation between perioperative levosimendan administration and increased bleeding risk using a meta-analysis study design.
Methods
The PubMed, Ovid, EMBASE and Cochrane Library databases were searched for relevant RCTs before July 1, 2019. The outcome parameters included reoperation secondary to increased bleeding in the postoperative period, the amount of postoperative recorded blood loss, and the need for transfusion of packed red blood cells (RBCs) and other blood products.
Results
A total of 1160 patients in nine RCTs (576 in the levosimendan group and 584 in the control group) were included according to our inclusion criteria. Analysis showed that perioperative levosimendan administration neither increased the rate of reoperation secondary to bleeding nor increased the amount of postoperative chest tube drainage when compared with the control group. In terms of blood product transfusion, levosimendan did not influence the requirement for RBC transfusion, platelet transfusion nor fresh frozen plasma (FFP) transfusion. Levosimendan also did not shorten or prolong the aortic cross-clamp time or the cardiopulmonary bypass time.
Conclusion
The analyzed parameters, including reoperations due to bleeding, postoperative chest drainage and the requirement for blood products, revealed that levosimendan did not increase postoperative bleeding risk. More studies with a larger sample size are needed to address a more reliable conclusion due to study limitations.</description><identifier>ISSN: 1175-3277</identifier><identifier>EISSN: 1179-187X</identifier><identifier>DOI: 10.1007/s40256-019-00372-2</identifier><identifier>PMID: 31523760</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Bias ; Blood platelets ; Blood products ; Blood Transfusion ; Blood transfusions ; Cardiac Surgical Procedures - methods ; Cardiology ; Cardiotonic Agents - administration & dosage ; Cardiotonic Agents - adverse effects ; Clinical trials ; Heart surgery ; Humans ; Medicine ; Medicine & Public Health ; Meta-analysis ; Perioperative Care - methods ; Pharmacology/Toxicology ; Pharmacotherapy ; Postoperative Hemorrhage - epidemiology ; Randomized Controlled Trials as Topic ; Risk ; Simendan - administration & dosage ; Simendan - adverse effects ; Studies ; Systematic Review</subject><ispartof>American journal of cardiovascular drugs : drugs, devices, and other interventions, 2020-04, Vol.20 (2), p.149-160</ispartof><rights>Springer Nature Switzerland AG 2019</rights><rights>Copyright Springer Nature B.V. Apr 2020</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-5e335e1255c8216ca065fc934f66b22d044321f4806736c0a7a79e3c682731ff3</citedby><cites>FETCH-LOGICAL-c375t-5e335e1255c8216ca065fc934f66b22d044321f4806736c0a7a79e3c682731ff3</cites><orcidid>0000-0001-5681-7843</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40256-019-00372-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40256-019-00372-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31523760$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yan, Sen-bo</creatorcontrib><creatorcontrib>Wang, Xiao-yan</creatorcontrib><creatorcontrib>Shang, Guo-kai</creatorcontrib><creatorcontrib>Wang, Zhi-hao</creatorcontrib><creatorcontrib>Deng, Qi-ming</creatorcontrib><creatorcontrib>Song, Jia-wen</creatorcontrib><creatorcontrib>Sai, Wen-wen</creatorcontrib><creatorcontrib>Song, Ming</creatorcontrib><creatorcontrib>Zhong, Ming</creatorcontrib><creatorcontrib>Zhang, Wei</creatorcontrib><title>Impact of Perioperative Levosimendan Administration on Risk of Bleeding After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials</title><title>American journal of cardiovascular drugs : drugs, devices, and other interventions</title><addtitle>Am J Cardiovasc Drugs</addtitle><addtitle>Am J Cardiovasc Drugs</addtitle><description>Background
Levosimendan, a calcium sensitizer and potassium channel opener, has been demonstrated to improve myocardial function without increasing oxygen consumption and to show protective effects in other organs. Recently, a prospective, randomized controlled trial (RCT) revealed an association between levosimendan use and a possible increased risk of bleeding postoperatively. Levosimendan’s anti-platelet effects have been shown in in vitro studies. Current studies do not provide sufficient data to support a relation between perioperative levosimendan administration and increased bleeding risk.
Purpose
Our goal was to investigate the relation between perioperative levosimendan administration and increased bleeding risk using a meta-analysis study design.
Methods
The PubMed, Ovid, EMBASE and Cochrane Library databases were searched for relevant RCTs before July 1, 2019. The outcome parameters included reoperation secondary to increased bleeding in the postoperative period, the amount of postoperative recorded blood loss, and the need for transfusion of packed red blood cells (RBCs) and other blood products.
Results
A total of 1160 patients in nine RCTs (576 in the levosimendan group and 584 in the control group) were included according to our inclusion criteria. Analysis showed that perioperative levosimendan administration neither increased the rate of reoperation secondary to bleeding nor increased the amount of postoperative chest tube drainage when compared with the control group. In terms of blood product transfusion, levosimendan did not influence the requirement for RBC transfusion, platelet transfusion nor fresh frozen plasma (FFP) transfusion. Levosimendan also did not shorten or prolong the aortic cross-clamp time or the cardiopulmonary bypass time.
Conclusion
The analyzed parameters, including reoperations due to bleeding, postoperative chest drainage and the requirement for blood products, revealed that levosimendan did not increase postoperative bleeding risk. More studies with a larger sample size are needed to address a more reliable conclusion due to study limitations.</description><subject>Bias</subject><subject>Blood platelets</subject><subject>Blood products</subject><subject>Blood Transfusion</subject><subject>Blood transfusions</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Cardiology</subject><subject>Cardiotonic Agents - administration & dosage</subject><subject>Cardiotonic Agents - adverse effects</subject><subject>Clinical trials</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Perioperative Care - methods</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Postoperative Hemorrhage - epidemiology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk</subject><subject>Simendan - administration & dosage</subject><subject>Simendan - adverse effects</subject><subject>Studies</subject><subject>Systematic Review</subject><issn>1175-3277</issn><issn>1179-187X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9UdFqFDEUDaLYuvoDPkjA52iSO0lmfFuXqoUtlVrBtyHN3JTUmWRNZgvbj_Cbm-1WfRMunAv3nHMv9xDyWvB3gnPzvjRcKs246BjnYCSTT8ixEKZjojU_nj70ioE05oi8KOWGc2Gk6Z6TIxBKgtH8mPw-nTbWzTR5-hVzSBvMdg63SNd4m0qYMA420uUwhRjKvJ-lSGtdhPJzL_o4Ig4hXtOlnzHTlc1DsI5-2-ZrzLsPdEnPcLbMRjvuSih7yYWNQ5rCHQ50leKc0zjW9jIHO5aX5JmvgK8ecUG-fzq5XH1h6_PPp6vlmjkwamYKARQKqZRrpdDOcq2866DxWl9JOfCmASl803JtQDtujTUdgtOtNCC8hwV5e_Dd5PRri2Xub9I21yNLL6FtVAsCusqSB5bLqZSMvt_kMNm86wXv9xH0hwj6GkH_EEFVL8ibR-vt1YTDX8mfn1cCHAiljmJ907_d_7G9B9BQkfU</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Yan, Sen-bo</creator><creator>Wang, Xiao-yan</creator><creator>Shang, Guo-kai</creator><creator>Wang, Zhi-hao</creator><creator>Deng, Qi-ming</creator><creator>Song, Jia-wen</creator><creator>Sai, Wen-wen</creator><creator>Song, Ming</creator><creator>Zhong, Ming</creator><creator>Zhang, Wei</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><orcidid>https://orcid.org/0000-0001-5681-7843</orcidid></search><sort><creationdate>20200401</creationdate><title>Impact of Perioperative Levosimendan Administration on Risk of Bleeding After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials</title><author>Yan, Sen-bo ; Wang, Xiao-yan ; Shang, Guo-kai ; Wang, Zhi-hao ; Deng, Qi-ming ; Song, Jia-wen ; Sai, Wen-wen ; Song, Ming ; Zhong, Ming ; Zhang, Wei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-5e335e1255c8216ca065fc934f66b22d044321f4806736c0a7a79e3c682731ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bias</topic><topic>Blood platelets</topic><topic>Blood products</topic><topic>Blood Transfusion</topic><topic>Blood transfusions</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Cardiology</topic><topic>Cardiotonic Agents - administration & dosage</topic><topic>Cardiotonic Agents - adverse effects</topic><topic>Clinical trials</topic><topic>Heart surgery</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Perioperative Care - methods</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Postoperative Hemorrhage - epidemiology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk</topic><topic>Simendan - administration & dosage</topic><topic>Simendan - adverse effects</topic><topic>Studies</topic><topic>Systematic Review</topic><toplevel>online_resources</toplevel><creatorcontrib>Yan, Sen-bo</creatorcontrib><creatorcontrib>Wang, Xiao-yan</creatorcontrib><creatorcontrib>Shang, Guo-kai</creatorcontrib><creatorcontrib>Wang, Zhi-hao</creatorcontrib><creatorcontrib>Deng, Qi-ming</creatorcontrib><creatorcontrib>Song, Jia-wen</creatorcontrib><creatorcontrib>Sai, Wen-wen</creatorcontrib><creatorcontrib>Song, Ming</creatorcontrib><creatorcontrib>Zhong, Ming</creatorcontrib><creatorcontrib>Zhang, Wei</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>American journal of cardiovascular drugs : drugs, devices, and other interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yan, Sen-bo</au><au>Wang, Xiao-yan</au><au>Shang, Guo-kai</au><au>Wang, Zhi-hao</au><au>Deng, Qi-ming</au><au>Song, Jia-wen</au><au>Sai, Wen-wen</au><au>Song, Ming</au><au>Zhong, Ming</au><au>Zhang, Wei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Perioperative Levosimendan Administration on Risk of Bleeding After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials</atitle><jtitle>American journal of cardiovascular drugs : drugs, devices, and other interventions</jtitle><stitle>Am J Cardiovasc Drugs</stitle><addtitle>Am J Cardiovasc Drugs</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>20</volume><issue>2</issue><spage>149</spage><epage>160</epage><pages>149-160</pages><issn>1175-3277</issn><eissn>1179-187X</eissn><abstract>Background
Levosimendan, a calcium sensitizer and potassium channel opener, has been demonstrated to improve myocardial function without increasing oxygen consumption and to show protective effects in other organs. Recently, a prospective, randomized controlled trial (RCT) revealed an association between levosimendan use and a possible increased risk of bleeding postoperatively. Levosimendan’s anti-platelet effects have been shown in in vitro studies. Current studies do not provide sufficient data to support a relation between perioperative levosimendan administration and increased bleeding risk.
Purpose
Our goal was to investigate the relation between perioperative levosimendan administration and increased bleeding risk using a meta-analysis study design.
Methods
The PubMed, Ovid, EMBASE and Cochrane Library databases were searched for relevant RCTs before July 1, 2019. The outcome parameters included reoperation secondary to increased bleeding in the postoperative period, the amount of postoperative recorded blood loss, and the need for transfusion of packed red blood cells (RBCs) and other blood products.
Results
A total of 1160 patients in nine RCTs (576 in the levosimendan group and 584 in the control group) were included according to our inclusion criteria. Analysis showed that perioperative levosimendan administration neither increased the rate of reoperation secondary to bleeding nor increased the amount of postoperative chest tube drainage when compared with the control group. In terms of blood product transfusion, levosimendan did not influence the requirement for RBC transfusion, platelet transfusion nor fresh frozen plasma (FFP) transfusion. Levosimendan also did not shorten or prolong the aortic cross-clamp time or the cardiopulmonary bypass time.
Conclusion
The analyzed parameters, including reoperations due to bleeding, postoperative chest drainage and the requirement for blood products, revealed that levosimendan did not increase postoperative bleeding risk. More studies with a larger sample size are needed to address a more reliable conclusion due to study limitations.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31523760</pmid><doi>10.1007/s40256-019-00372-2</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-5681-7843</orcidid></addata></record> |
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| ispartof | American journal of cardiovascular drugs : drugs, devices, and other interventions, 2020-04, Vol.20 (2), p.149-160 |
| issn | 1175-3277 1179-187X |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Bias Blood platelets Blood products Blood Transfusion Blood transfusions Cardiac Surgical Procedures - methods Cardiology Cardiotonic Agents - administration & dosage Cardiotonic Agents - adverse effects Clinical trials Heart surgery Humans Medicine Medicine & Public Health Meta-analysis Perioperative Care - methods Pharmacology/Toxicology Pharmacotherapy Postoperative Hemorrhage - epidemiology Randomized Controlled Trials as Topic Risk Simendan - administration & dosage Simendan - adverse effects Studies Systematic Review |
| title | Impact of Perioperative Levosimendan Administration on Risk of Bleeding After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials |
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