Conference: 2014 International PHA Conference and Scientific Sessions
Release Date: 06.21.2014
Presentation Type: Abstracts
File Download: 2014 Conference Abstract - Eric Fenstad
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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