A63-29 Successful Transition From IV Epoprostenol to Oral Treprostinil in Pulmonary Arterial Hypertension: A Case Report
Abstract
Pulmonary arterial hypertension (PAH), particularly group 1, is managed with prostacyclin analogs like epoprostenol, delivered intravenously (IV). However, complications of IV therapy, including infections, catheter issues, and the risk of rapid decompensation during interruptions, highlight the need for oral alternatives. Treprostinil, a prostacyclin analog with a longer half-life and more stable formulation, offers oral (PO) and inhaled options. While manufacturer guidelines exist for IV-to-IV or IV-to-PO treprostinil transitions, no specific protocol for converting from IV epoprostenol to PO treprostinil is available. A 48-year-old female with PAH and systemic lupus erythematosus with thrombocytopenia presented for outpatient consultation due to complications related to her Hickman line, used for IV epoprostenol. Diagnosed with PAH in 2004, her treatment history included multiple transitions between IV epoprostenol and oral agents like sildenafil, tadalafil, and selexipag due to worsening hemodynamics. Initial treatment around the time of her diagnosis was limited due to her inability tolerate up titration of PO treprostinil due to significant headache and diarrhea. At the time of consultation, the patient was on IV epoprostenol, sildenafil, and ambrisentan. A dislodged Hickman line prompted hospitalization for conversion from IV epoprostenol to PO treprostinil. Upon admission, a peripherally inserted central catheter (PICC) was placed due to extensive venous thrombosis.…
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