Postpericardiotomy Syndrome Medication

Updated: Dec 30, 2020
  • Author: M Silvana Horenstein, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Medication Summary

The mainstay of medical therapy is use of anti-inflammatory agents. Various drugs are available; all have similar efficacy. Corticosteroids are often used in more severe or refractory cases. Corticosteroids have resulted in rapid improvement in clinical symptoms and decrease in antiheart antibodies.

No evidence suggests that steroids administered prior to cardiopulmonary bypass reduce the risk of developing postpericardiotomy syndrome. [24] One case has been reported of low-dose methotrexate used in postpericardiotomy syndrome refractory to standard therapy [39] ; however, this has not been further supported.


Anti-inflammatory agents

Class Summary

These agents decrease inflammatory responses and interfere with systemic events leading to inflammation.

Aspirin (Anacin, Ascriptin, Bayer Aspirin, Bayer Buffered Aspirin)

First-line medication for patients with PPS. Inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2.

Indomethacin (Indocin)

Nonsteroidal anti-inflammatory medication often used as a first-line drug in PPS. Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.

Prednisone (Deltasone, Orasone, Sterapred)

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Usually reserved for treating more severe cases or relapses. May also be used as a first-line drug. Corticosteroid use has been shown to result in faster resolution of symptoms than other therapies.