Double-blind, placebo-controlled study of intravenous prostacyclin on
hemodynamics in severe Raynaud's phenomenon: the acute vasodilatory effect is not
sustained.
Author(s): Kingma K(1), Wollersheim H, Thien T.
Affiliation(s): Author information:
(1)Department of Medicine, University Hospital, Nijmegen, The Netherlands.
Publication date & source: 1995, J Cardiovasc Pharmacol. , 26(3):388-93
In 12 patients with severe Raynaud's phenomenon (RP: ischemic ulcers or
intractable pain despite use of narcotic analgetics), we studied the acute and
long-term hemodynamic effects of epoprostenol on systemic and finger skin
circulation. Epoprostenol was infused intravenously (i.v., initial infusion rate
of 2 ng/kg/min, with a subsequent increase of 2 ng/kg/min every 30 min to the
individually tolerated maximal dose of 8 ng/kg/min) in a triple, 5-h,
double-blind, placebo-controlled cross-over study. During epoprostenol infusion,
systolic blood pressure (SBP) remained stable, while diastolic BP (DBP) decreased
(-8 mm Hg, p < 0.02), with a simultaneous increase in heart rate (HR + 14
beats/min, p < 0.001). Forearm blood flow (FBF) increased and forearm vascular
resistance (FVR) decreased during epoprostenol as compared with placebo infusion
(p < 0.01). Epoprostenol caused a significant increase in fingertip skin
temperature (p < 0.01) as well as in laser Doppler flux (p < 0.02) before and
after a standardized cooling test of the hand as compared with placebo. The
increase in transcutaneous oxygen tension reached significant difference only
during recovery (p < 0.02). No long-term improvement was noted during two
additional cooling tests performed 1 and 6 weeks after the completed epoprostenol
or placebo triple-infusion cycle. Repeated long-lasting epoprostenol infusion
immediately improves the microcirculation, but these effects are not sustained
after 1 week.
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