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Normal and Abnormal Endothelial Release of Tissue-Type Plasminogen Activator
Published in Pia Glas-Greenwalt, Fibrinolysis in Disease Molecular and Hemovascular Aspects of Fibrinolysis, 2019
The vasopressin analogue DDAVP, originally developed as an analogue that mimicked vasopressin’s antidiuretic effect without its vasoactive side effects, was subsequently shown also to increase plasma levels of vWF, coagulation factor VTA, and t-PA (for reviews, see References 55 to 57). In the field of hemostasia DDAVP has subsequently been used to increase plasma levels of factor Vfll/vWF, e.g., in FVTH- or vWF-deficient patients prior to minor surgery, and in blood donors prior to blood donation.55,56 The application of DDAVP’s potential to increase the plasma level of t-PA has been largely restricted to evaluating fibrinolytic responses.
Drug therapy for portal hypertension
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Terlipressin is a synthetic vasopressin analogue (triglycyl lysine vasopressin), which, in addition to an intrinsic vasoconstrictor activity, is slowly converted in vivo into vasopressin by enzymatic cleavage of the triglycyl residues. This allows a slow but continuous release of vasopressin resulting in a lower incidence of side-effects when compared with vasopressin, while maintaining a significant decrease in portal pressure. In addition, terlipressin, unlike vasopressin, does not enhance fibrinolysis and has a longer biological activity, which makes continuous intravenous infusion unnecessary.22 The preferred schedule of administration is intravenous injection of 2 mg/4 h until achieving a bleeding-free period of 24–48 h.
Drugs causing cutaneous necrosis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
The term vasculopathy or pseudovasculitis is used to describe certain degrees of vascular alterations and injuries that fail to satisfy the criteria of vasculitis. Some instances of drug-induced vasculopathic reactions may manifest as cutaneous necrosis. Vasopressin and its analogues are known to cause peripheral vasoconstriction leading to cutaneous necrosis. Terlipressin, an arginin-vasopressin analogue with high V1-receptor affinity, when used in treatment of hepatorenal syndrome and esophageal varices has been reported to cause cutaneous necrosis in several case reports [15–22]. Skin lesions most commonly involve the thighs and abdomen followed by scrotum in men [23]. Use of vasopressin has been associated with cutaneous necrosis and bullous lesions along with rhabdomyolysis in another case report [24].
Pharmacological management of sepsis in adults with a focus on the current gold standard treatments and promising adjunctive strategies: evidence from the last five years
Published in Expert Opinion on Pharmacotherapy, 2019
Evdoxia Kyriazopoulou, Evangelos J. Giamarellos-Bourboulis
Vasopressin and its analogue terlipressin are considered potent vasopressors and might have a place in the treatment of septic shock. The only RCT conducted the last five years is the VANISH trial, which explored the possible benefit of vasopressin on renal function. One hundred and one patients were randomly allocated to vasopressin (titrated up to 0.06 U/min) and hydrocortisone, 104 patients to vasopressin and placebo, 101 patients to norepinephrine and hydrocortisone and 103 patients to norepinephrine and placebo [45]. Patients were recruited within a 6-h window. Mortality was indifferent between the four groups but a slight, though non-significant, decrease of creatinine and increase of urine output was observed in those patients treated with vasopressin compared to norepinephrine. Renal failure-free days did not differ between the treatment groups, but renal replacement was obligatory in 25.4% of vasopressin-treated patients versus 35.3% of norepinephrine-treated patients (OR 0.4; 95% CI 0.2–0.73). Life-threatening arrhythmias were rare and indifferent between the two groups. Selepressin, a novel vasopressin analogue, is a potent, highly selective, full agonist of the vasopressin 1A receptor and is currently been studied in the double-blind, placebo-controlled, Phase 2b/3 SEPSIS-ACT trial (NCT02508649).
Usefulness of prolactin measurement in inferior petrosal sinus sampling with desmopressin for Cushing’s syndrome
Published in British Journal of Neurosurgery, 2020
Hamideh Akbari, Mohammad Ghorbani, Maryam Kabootari, Ali Zare Mehrjardi, Mohammad Reza Mohajeri Tehrani, Mojtaba Malek, Mohammad E. Khamseh
Bilateral inferior petrosal sinus sampling (IPSS) is used to differentiate EAS from CD. A petrosal sinus to peripheral (IPS/P) ACTH ratios ≥2 at baseline or ≥3 after CRH administration are diagnostic for CD with overall sensitivity and specificity of 94%,7 and false-negative results of 1–10%.8 Desmopressin (DDAVP), a long-acting synthetic vasopressin analogue that binds to pituitary vasopressin receptors is a potent stimulus for ACTH secretion with a similar accuracy as CRH.9