Angiotensin receptor antagonists during dextran sulfate LDL-apheresis are safe

Severe life-threatening anaphylactoid reactions have been seen with dextran-sulfate LDL-apheresis under the concomitant use of angiotensin-converting enzyme inhibitors, even after stopping treatment for several half-lifes of the drug. In this study we showed in 3 patients (4 therapeutic sessions each) that under the administration of angiotensin antagonists during LDL-apheresis, there is a flow-dependent increase in bradykinin values after the column run. The bradykinin increase is comparable to the one without angiotensin receptor antagonists and thus clinically irrelevant. The kinetics of bradykinin in different LDL-apheresis sessions are similar. No clinical side effects were seen. A 6-month follow-up in these 3 patients revealed no problems. Angiotensin receptor antagonists are thus a safe alternative to angiotensin-converting enzyme inhibitors in these patients.