Calendar | For Your Patients | PHA Main Site | Contact Us | About Us | Not a registered user? Sign up here.

Resource Library

Safety of Outpatient Initiation of Intravenous Epoprostenol Therapy in Patients with Pulmonary Arterial Hypertension

Reviews

  Sign in to add a review

0 comments
Leave a Comment

Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.21.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Eric Fenstad

Download Adobe Acrobat

Initiation of intravenous epoprostenol treatment of pulmonary arterial hypertension (PAH) has generally been done in an inpatient setting. We report our experience of outpatient initiation of epoprostenol.

Background: Initiation of intravenous epoprostenol treatment of pulmonary arterial hypertension (PAH) has generally been done in an inpatient setting. We report our experience of outpatient initiation of epoprostenol.

Methods: Retrospective single-center study of all consecutive patients with PAH initiated on epoprostenol at a tertiary referral pulmonary hypertension center from 1992-2005. 

Results: 242 patients were begun on treatment with epoprostenol during the study period (mean age 51 ± 14 years; 74% females). The majority of patients (96%) were World Health Organization class III or IV. Table 1 shows the baseline invasive hemodynamic profile prior to starting drug therapy. Epoprostenol was started in 150 (62%) patients in the outpatient setting. Complications from central venous catheter insertion were rare: 1 patient had a postoperative hematoma and 2 patients developed pneumothorax. Follow up was complete in 218 (90%) patients with a mean follow-up of 4.6 ± 7.9 years (range 14 days-9.9 years). Patients experienced the following catheter-related complications (first adverse event) during follow up: 56 central venous catheter site infections, 26 blood stream infections, 22 catheter dislodgements, 9 catheter fractures, 6 catheter obstructions, and 1 embolic event. Equipment complications were rare (1 pump malfunction). Long-term additional subsequent events included: 29 site infections, 22 blood stream infections, 14 catheter dislodgements, 7 catheter fractures, 4 embolic events, 2 catheter obstructions, and 1 pump malfunction. 

Table 1. Hemodynamics on right heart catheterization prior to epoprostenol initiation.

RAP (mmHg) mPAP (mmHg) PCWP (mmHg) CI (L/min/m2)
13 +/- 8 56 +/- 13 13 +/- 7 2.44 +/- 0.79

RAP-right atrial pressure, MPAP-mean pulmonary artery pressure; PCWP-pulmonary capillary wedge pressure; CI-caridac index

Conclusion: The majority of patients had intravenous epoprostenol started safely in the outpatient setting, but subsequently experienced frequent complications typical of this mode of treatment. Central venous catheter- or drug-related complications at the time of drug initiation were rare. Although pump malfunction rarely occurred, catheter-related complications were common with almost half of all patients experiencing an adverse event. Outpatient initiation of epoprostenol appears to be safe for many patients with PAH. 

Type: Clinical Science