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February 15, 1995

Hypotension During Sham Apheresis in a Patient Taking ACE Inhibitors-Reply

Author Affiliations

Tokyo Women's Medical College Tokyo, Japan

JAMA. 1995;273(7):521. doi:10.1001/jama.1995.03520310012009

In Reply.  —Marked elevation of bradykinin concentration in contact with a polysulfone plasma separator, the membrane material of which is also charged negative, has been reported by Koga et al.1 Administration of an ACE inhibitor during LDL adsorption with a DSC must be done with extreme care, according to an official notice from the Japanese Ministry of Health and Welfare, distributed October 21, 1993.Recently, Sinzinger et al2 reported data concluding that use of ACE inhibitors with a shorter half-life or withdrawal of the compounds more than 24 hours before LDL apheresis is not safe enough.As we noted in our original letter, the protease inhibitor nafamostat mesylate (FUTHAN, Torii Pharmaceutical Co Ltd, Tokyo, Japan), which is widely used as an anticoagulant for extracorporeal circulation but currently commercially available only in Japan, is known to inhibit release and accumulation of bradykinin even with concomitant administration of ACE inhibitors.

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