The effects of ranitidine and hydrocortisone on the complications of femoral artery obstruction treated by streptokinase following cardiac catheterization in pediatric patients with congenital heart diseases

Noori, N. and Aliabad, G.M. and Mohammadi, M. and Mahjoubifard, M. and Fard, A.J. (2013) The effects of ranitidine and hydrocortisone on the complications of femoral artery obstruction treated by streptokinase following cardiac catheterization in pediatric patients with congenital heart diseases. Iranian Red Crescent Medical Journal, 15 (2).

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Background: The most important complication following cardiac catheterization required urgent therapeutic management is vessel obstruction and arterial thrombosis. The morbidity following this complication can be decreased by surgery intervention and/or thrombolytic drugs. Objectives: In this study we evaluated the effects of ranitidine and hydrocortisone in pediatric patients with congenital heart diseases who suffered from femoral artery obstruction following cardiac catheterization on decreasing the events after streptokinase administration. Materials and Methods: This semi experimental study was conducted on 47 patients among 600 cases who underwent cardiac catheterization from April 2002 to December 2011.The patients suffered from distal vessel obstruction following cardiac catheterization with no response to surgery intervention, were enrolled and divided in two groups. Streptokinase was administrated in both groups. Patients in group 2 (25 cases) received ranitidine and hydrocortisone before streptokinase administration. In first group (22 patients), the loading dose of streptokinase was 2000IU/kg/ in 20-30 minutes/ infusion and thereafter streptokinase was administrated 1000 IU /kg/hour. In group 2, the loading dose was 3000IU/kg in 20-30 minutes /infusion and 1500 IU/kg/hour as maintenance dose. The infusion dose of streptokinase was decreased and then terminated in 2-3 hours by the time arterial pulse was detected by pulse oximetry. Results: There were 13 (59, 1) male and 9 (40.9) female patients in group 1. In group 2, there were 15 (60) male and 10 (40) female cases (P = 0.949). Patients in both groups were matched well regarding age, body weight, height and the duration of streptokinase infusion (P < 0.05). The incidence of hematoma was higher in group 1 than group 2 (P = 0.032). Group 1 patients required more blood transfusion than group 2 because the incidence of bleeding was more in the first group (P = 0.042). Twelve patients in group 1 required fresh frozen plasma transfusion versus 4 patients in group 2 (P = 0.049). Local oozing was detected more in group 1 (P = 0.042). Significant bleeding was occurred in 6 cases in group 1; however this event was not occurred in any patients in group 2 (P = 0.007). Four patients in group 1 suffered from anaphylactic shock after streptokinase administration, no patients in group 2 suffered from this complication though (P = 0.041). Conclusions: Based on the results of this study, we concluded that streptokinase was able to remove the vessel thrombosis at the site of cardiac catheterization and ranitidine and hydrocortisone administration before streptokinase may be effective in order to reduce the complications related to thrombolytic drugs; however the experience of the performer is an issue of concern in this matter.

Item Type: Article
Additional Information: cited By 0
Uncontrolled Keywords: cimetidine; fresh frozen plasma; hemoglobin; heparin; hydrocortisone; morphine; pethidine; ranitidine; streptokinase, adolescent; anaphylactic shock; anemia; artery occlusion; artery thrombosis; article; bleeding; blood transfusion; child; clinical article; congenital heart disease; Doppler echocardiography; drug dose reduction; drug withdrawal; female; femoral artery; fever; follow up; heart catheterization; hematoma; human; human experiment; male; partial thromboplastin time; plasma transfusion; preschool child; prothrombin time; pulse oximetry; school child; seizure; single drug dose
Subjects: WG Cardiovascular System
WS Pediatrics
QV Pharmacology
Depositing User: somayeh pourmorteza
Date Deposited: 26 Feb 2019 08:28
Last Modified: 26 Feb 2019 08:28

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