• J. Cardiothorac. Vasc. Anesth. · Aug 2019

    Meta Analysis

    The Role of Tolvaptan Administration After Cardiac Surgery: A Meta-Analysis.

    • Ioannis Bellos, Dimitrios C Iliopoulos, and Despina N Perrea.
    • Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and KaPOD istrian University of Athens, Athens, Greece. Electronic address: bellosg@windowslive.com.
    • J. Cardiothorac. Vasc. Anesth. 2019 Aug 1; 33 (8): 2170-2179.

    ObjectiveTo evaluate the efficacy and safety of tolvaptan in fluid management after cardiac surgery compared with conventional diuretic treatment.DesignSystematic review of the literature with meta-analyses.SettingThe Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar databases were searched from inception to July 30, 2018.ParticipantsThe study comprised 759 patients undergoing cardiac surgery.InterventionsTolvaptan administration (n = 397) or standard diuretic therapy (n = 398).Measurements And Main ResultsTen studies were included in the present meta-analysis. Tolvaptan administration was associated with a significantly faster return to preoperative body weight (mean difference [MD)] -1.48 d, 95% confidence interval [CI] -1.92 to 1.03), shorter duration of hospital stay (MD -2.58 d, 95% CI -5.09 to -0.07), lower incidence of acute kidney injury (odds ratio 0.34, 95% CI 0.16-0.69), and greater urine output (MD 0.47 L/d, 95% CI 0.25-0.69) and sodium levels (MD 2.85 mEq/L, 95% CI 1.90-3.80). No significant differences were present regarding duration of intensive care unit stay (MD -0.09 d, 95% CI -0.33 to 0.15), arrhythmia incidence (odds ratio 0.58, 95% CI 0.33-1.02), and serum creatinine values (MD -0.08 mg/dL, 95% CI -0.20 to 0.04).ConclusionsThe outcomes of the present meta-analysis suggest the promising role of tolvaptan administration in the management of fluid retention in patients after cardiac surgery. Future large-scale clinical trials should be conducted to fully elucidate its efficacy and to assess the optimal treatment protocol to be applied in the clinical setting.Copyright © 2018 Elsevier Inc. All rights reserved.

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