Snipelisky David, Shipman Justin, Olson Nicole, Pellikka Patricia, Aqel Bashar, McCully Robert, Watt Kymberly
1 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
2 Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA.
Prog Transplant. 2018 Dec;28(4):361-367. doi: 10.1177/1526924818800048. Epub 2018 Sep 16.
Dobutamine stress echocardiography (DSE) is frequently used to screen for obstructive coronary artery disease in the pre-liver transplant evaluation. Although atropine is a commonly used adjunctive medication, no study has evaluated its side effect profile in patients with end-stage liver disease (ESLD).
What is the safety of atropine in candidates undergoing pre-liver transplant evaluation when atropine is used in stress testing?
This multicenter, prospective study enrolled patients over a 6-month period undergoing pre-liver transplant evaluation. Each patient completed a questionnaire assessing anticholinergic-related symptoms within 24 hours of testing and 48 hours following. Comparisons were made among patients receiving any atropine dose versus those who did not and among patients receiving at least 1 mg atropine and those receiving less/none.
Forty patients were evaluated, and 32 (80%) had adjunctive atropine administered. No differences in clinical characteristics were noted. In comparisons among patients receiving any dose of atropine with those who did not, questionnaire results indicated a higher rate of nausea prior to testing and higher overall symptom severity following testing in patients not receiving atropine. In comparisons among patients receiving less than 1 mg atropine with those receiving at least 1 mg atropine, no difference in pre- or posttesting questionnaire responses was present. No patient in the study required reversal agents or hospitalization within 7 days of testing.
Atropine, a hepatically metabolized medication, did not predispose patients with ESLD to an increased symptom burden, and clinical outcomes related to DSE were unaffected.
多巴酚丁胺负荷超声心动图（DSE）常用于肝移植术前评估中筛查阻塞性冠状动脉疾病。尽管阿托品是常用的辅助药物，但尚无研究评估其在终末期肝病（ESLD）患者中的副作用情况。
在肝移植术前评估中，当阿托品用于负荷试验时，其安全性如何？
这项多中心前瞻性研究在6个月内纳入了接受肝移植术前评估的患者。每位患者在测试后24小时内及之后48小时内完成一份评估抗胆碱能相关症状的问卷。对接受任何剂量阿托品的患者与未接受阿托品的患者，以及接受至少1毫克阿托品的患者与接受较少/未接受阿托品的患者进行了比较。
评估了40例患者，其中32例（80%）使用了辅助性阿托品。未观察到临床特征的差异。在接受任何剂量阿托品的患者与未接受阿托品的患者的比较中，问卷结果显示未接受阿托品的患者在测试前恶心发生率较高，且测试后总体症状严重程度较高。在接受少于1毫克阿托品的患者与接受至少1毫克阿托品的患者的比较中，测试前后问卷回答无差异。研究中没有患者在测试后7天内需要使用逆转剂或住院治疗。
阿托品是一种经肝脏代谢的药物，不会使ESLD患者的症状负担增加，且与DSE相关的临床结果未受影响。
