Bisoprolol/dextran sulfate
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Systemic malaise and presyncope: case report A 62-year-old man developed systemic malaise and presyncope following treatment with dextran sulfate and bisoprolol for Takotsubo syndrome or lipoprotein apheresis therapy to treat hyper-lipoprotein(a) [routes not stated; not all dosages stated; time to reaction onsets not clearly stated]. The man, who had hyper-lipoprotein(a), polygenic hypercholesterolaemia and coronary atherosclerotic disease, started receiving lipoprotein apheresis therapy. The lipoprotein apheresis was performed every two weeks in which 5000mL of plasma was treated per session with dextran sulfate [dextran sulphate] system. He was also receiving atorvastatin and aspirin/clopidogrel. His medical history was significant for non-ST segment elevation myocardial infarction and percutaneous coronary artery revascularisation. Five months after initiation of lipoprotein apheresis therapy, he developed acute episode of Takotsubo syndrome triggered by sexual act. Subsequently, he started receiving bisoprolol 1.25mg once a day. One month after the Takotsubo episode, he underwent his next lipoprotein apheresis session. However, during lipoprotein apheresis, he developed systemic malaise, sweating and presyncope. The episode developed half an hour after initiation of lipoprotein apheresis session. At the time of this episode, 600mL of plasma volume had been treated. His blood pressure was also noted to be low. The man was treated with methylprednisolone and fluids. Thereafter, his systemic malaise, sweating and presyncope resolved. His blood pressure was poorly responsive to this treatment. He was diagnosed with hypovolemic shock [aetiology not stated]. Lipoprotein apheresis therapy was discontinued. Dextran sulfate was suspected to have contributed in the development of systemic malaise. Also, bisoprolol therapy was suspected to be risk factor in the development of presyncope. Two months later, lipoprotein apheresis was re-initiated with precautions of limiting the blood flow and administration of a bolus of physiological solution. No complications were observed. Dal Pino B, et al. Recent TakoTsubo syndrome and lipoprotein apheresis: An alert for a safe procedure. European Journal of Preventive Cardiology 27: 444-446, No. 4, Mar 803504160 2020. Available from: URL: http://doi.org/10.1177/2047487319835635
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Reactions 3 Oct 2020 No. 1824
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