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Efficacy and safety measures for low density lipoprotein apheresis treatment using dextran sulfate cellulose columns
1Shin-Koga Hospital, Kurume City, Japan.
Insights
Low-density lipoprotein (LDL) apheresis with dextran sulfate cellulose (DSC) columns effectively treats hypercholesterolemia and coronary heart disease (CHD). Careful management of ACE inhibitors is crucial to prevent adverse reactions during LDL apheresis.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Drug-refractory hypercholesterolemia poses significant risks for coronary heart disease (CHD).
- Low-density lipoprotein (LDL) apheresis is an established treatment for severe hypercholesterolemia.
- Dextran sulfate cellulose (DSC) columns are utilized for LDL apheresis.
Purpose of the Study:
- To evaluate the efficacy and safety of long-term LDL apheresis using DSC columns.
- To assess the benefits of combining LDL apheresis with cholesterol-lowering drugs.
- To identify and mitigate adverse reactions associated with LDL apheresis.
Main Methods:
- Long-term LDL apheresis treatment utilizing DSC columns.
- Combination therapy with cholesterol-lowering drugs.
- Monitoring for adverse events, including hypotension and anaphylactoid reactions.
Main Results:
- LDL apheresis using DSC columns is generally well-tolerated for long-term use.
- Combined therapy may prevent atherosclerosis progression, stabilize plaques, and reduce cardiac events.
- Major adverse reactions include hypotension and potential anaphylactoid reactions with ACE inhibitors.
Conclusions:
- LDL apheresis with DSC columns is a safe and effective treatment for hypercholesterolemia and CHD.
- Concurrent ACE inhibitor use must be avoided due to the risk of severe anaphylactoid reactions.
- This therapy offers significant cardiovascular benefits for high-risk patients.
Abstract:
Long-term low density lipoprotein (LDL) apheresis using dextran sulfate cellulose (DSC) columns is a well tolerated treatment for drug refractory hypercholesterolemia with coronary heart disease (CHD). Hypercholesterolemic patients may benefit from LDL apheresis combined with cholesterol lowering drug therapy in terms of the prevention of the progression of atherosclerosis, stabilization of atheromatous plaque, and reduction of cardiac events. The major adverse reaction of LDL apheresis is temporal hypotension caused by hypovolemia or vasovagal reactions due to extracorporeal circulation. Anaphylactoid reactions in patients administered angiotensin converting enzyme inhibitors (ACE-I) are other dextran sulfate cellulose column related adverse reactions, which must be carefully prevented by ceasing the administration of ACE-I before LDL apheresis treatment. ACE-I must not be administered to patients undergoing LDL apheresis.