Pediatric Cardiology for Practitioners: Expert Consult - Online by Park Myung K

Author:Park, Myung K. [Park, Myung K.]
Language: eng
Format: epub
ISBN: 9780323294317
Publisher: Elsevier Health Sciences
Published: 2014-02-26T00:00:00+00:00

Management

1. Attempts to prevent anthracycline cardiotoxicity have been directed toward (a) anthracycline dose limitation, (b) method of drug administration, (c) developing less cardiotoxic analogs, and (d) concurrently administering cardioprotective agents to attenuate the cardiotoxic effects of anthracycline to the heart.a. Restriction of the total dose is controversial. Limiting the total cumulative dose to 400 to 500 mg/m2 reduces the incidence of CHF to 5%, but this dose may not be effective in treating some malignancies.

b. Continuous slow infusion therapy may reduce cardiac injury by avoiding peak levels. At least one study recommends infusion over 6 hours. However, a more recent study (Lipshultz et al, 2012) has reported no long-term cardioprotection of continuous infusion over bolus infusion.

c. The analog of doxorubicin, such as idarubicin and epirubicin, has similar cardiotoxicity to that of doxorubicin. There is some suggestion of lower rate of clinical and subclinical heart failure in patients treated with liposomal encapsulated doxorubicin preparation.

d. Concurrent administration of the cardioprotective agents, such as dexrazoxane (an iron chelator), carvedilol (a β-receptor antagonist with antioxidant property), and coenzyme Q10, has shown varying levels of protective effects. Among these, dexrazoxane appears to be most cardioprotective, and some authorities recommend dexrazoxane to be included in the pediatric oncology protocol.

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