PulmCrit (EMCrit)
PulmCrit - January 2, 2018 - By Josh Farkas
"...Maybe angiotensin II is a fantastic vasopressor, but currently it's doubtful whether the benefits outweigh the risks. There are several reasons that angiotensin II isn't ready for widespread use:
- Angiotensin II has pro-inflammatory effects, causing increased levels of interleukin-6.
- Angiotensin II has pro-coagulant effects, which could increase microvascular thrombosis and the risk of DVT/PE.
- Angiotensin II inhibition improved survival in an animal model of sepsis, suggesting that excessive angiotensin II activity can be harmful.
- Angiotensin II hasn't been shown to improve any outcome other than a minor increase in blood pressure. Full stop.
- ATHOS-3 is underpowered to detect uncommon adverse events.
- The rationale for using angiotensin II is very similar to the rationale for using vasopressin. Although vasopressin is occasionally quite useful, it hasn't proven to be a wonder drug."