Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case Report
Background: Reperfusion serves as a mainstay therapy in almost all ischemic vascular diseases (IVD), but reperfusion may enhance cell damage after an ischemic period time. Increased ROS and inflammatory markers, decreasing organ function parameters, along with systemic inflammatory response and mult...
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| Language: | English |
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Interna Publishing
2025-01-01
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| Series: | Acta Medica Indonesiana |
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| Online Access: | https://actamedindones.org/index.php/ijim/article/view/2434 |
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| author | Dono Antono Ade Gautama Nindya P.B.S Utami |
| author_facet | Dono Antono Ade Gautama Nindya P.B.S Utami |
| author_sort | Dono Antono |
| collection | DOAJ |
| description | Background: Reperfusion serves as a mainstay therapy in almost all ischemic vascular diseases (IVD), but reperfusion may enhance cell damage after an ischemic period time. Increased ROS and inflammatory markers, decreasing organ function parameters, along with systemic inflammatory response and multi-organ damage may occur in ischemic reperfusion injury (IRI). Unfortunately, this series of events is unpredictable and sudden, causing high mortality in patients with IRI. Due to the significant role of inflammation in IRI, how is the effectiveness of anti-inflammatory agents administered before reperfusion therapy to prevent IRI? To know the efficacy of anti-inflammatory agents administered before reperfusion therapy to prevent IRI. Methods: A systematic search was conducted in databases (Pubmed, EMBASE, Scopus) and was later selected according to predetermined inclusion and exclusion criteria. Studies included later critically appraised using the CEBM Oxford questionnaire for randomized control trials and systematic review. Results: Seven studies were included among 1072 studies found in early searching. Six of the studies are randomized control trials, and one is a meta-analysis of randomized control trials. Methylprednisolone, pexelizumab, tirilazad mesylate, and N-acetylcysteine are known anti-inflammatory agents applicable in humans. The highest effectiveness of anti-inflammatory agents is methylprednisolone, with a relative risk reduction (RRR) of 75-85%. Besides that, pexelizumab also had an RRR of 27%, and tirilazad-mesylate had an RRR of 18%. N-acetylcysteine is not effective in preventing IRI. IL-6 levels postoperatively also decreased significantly in patients given anti-inflammatory agents before reperfusion therapy. There are no side effects of the intervention reported. Conclusion: Anti-inflammatory agent administration before reperfusion therapy effectively prevents IRI. The choices of anti-inflammatory agents recommended are methylprednisolone, pexelizumab, and tirilazad-mesylate. Anti-inflammatory agent administration before reperfusion therapy is recommended. |
| format | Article |
| id | doaj-art-e617474893044a0f9e1697b3f6720203 |
| institution | OA Journals |
| issn | 0125-9326 2338-2732 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Interna Publishing |
| record_format | Article |
| series | Acta Medica Indonesiana |
| spelling | doaj-art-e617474893044a0f9e1697b3f67202032025-08-20T02:17:34ZengInterna PublishingActa Medica Indonesiana0125-93262338-27322025-01-01571724Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case ReportDono Antono0Ade Gautama1Nindya P.B.S Utami2Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, IndonesiaIndependent Scholar, Jakarta, IndonesiaIndependent Scholar, Jakarta, IndonesiaBackground: Reperfusion serves as a mainstay therapy in almost all ischemic vascular diseases (IVD), but reperfusion may enhance cell damage after an ischemic period time. Increased ROS and inflammatory markers, decreasing organ function parameters, along with systemic inflammatory response and multi-organ damage may occur in ischemic reperfusion injury (IRI). Unfortunately, this series of events is unpredictable and sudden, causing high mortality in patients with IRI. Due to the significant role of inflammation in IRI, how is the effectiveness of anti-inflammatory agents administered before reperfusion therapy to prevent IRI? To know the efficacy of anti-inflammatory agents administered before reperfusion therapy to prevent IRI. Methods: A systematic search was conducted in databases (Pubmed, EMBASE, Scopus) and was later selected according to predetermined inclusion and exclusion criteria. Studies included later critically appraised using the CEBM Oxford questionnaire for randomized control trials and systematic review. Results: Seven studies were included among 1072 studies found in early searching. Six of the studies are randomized control trials, and one is a meta-analysis of randomized control trials. Methylprednisolone, pexelizumab, tirilazad mesylate, and N-acetylcysteine are known anti-inflammatory agents applicable in humans. The highest effectiveness of anti-inflammatory agents is methylprednisolone, with a relative risk reduction (RRR) of 75-85%. Besides that, pexelizumab also had an RRR of 27%, and tirilazad-mesylate had an RRR of 18%. N-acetylcysteine is not effective in preventing IRI. IL-6 levels postoperatively also decreased significantly in patients given anti-inflammatory agents before reperfusion therapy. There are no side effects of the intervention reported. Conclusion: Anti-inflammatory agent administration before reperfusion therapy effectively prevents IRI. The choices of anti-inflammatory agents recommended are methylprednisolone, pexelizumab, and tirilazad-mesylate. Anti-inflammatory agent administration before reperfusion therapy is recommended.https://actamedindones.org/index.php/ijim/article/view/2434ischemicreperfusion injuryreperfusionanti-inflammatory agents |
| spellingShingle | Dono Antono Ade Gautama Nindya P.B.S Utami Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case Report Acta Medica Indonesiana ischemic reperfusion injury reperfusion anti-inflammatory agents |
| title | Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case Report |
| title_full | Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case Report |
| title_fullStr | Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case Report |
| title_full_unstemmed | Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case Report |
| title_short | Anti-inflammatory Therapy Before Reperfusion Therapy in Patients with Ischemic Vascular Disease on the Incidence of Ischemic Reperfusion Injury: An Evidence-Based Case Report |
| title_sort | anti inflammatory therapy before reperfusion therapy in patients with ischemic vascular disease on the incidence of ischemic reperfusion injury an evidence based case report |
| topic | ischemic reperfusion injury reperfusion anti-inflammatory agents |
| url | https://actamedindones.org/index.php/ijim/article/view/2434 |
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