title: Erythropoietin in the treatment of postural orthostatic tachycardia syndrome.
abstract: Erythropoietin has been reported to improve symptoms of orthostatic intolerance in patients suffering from orthostatic hypotension. Previous reports on the use of erythropoietin in patients with postural orthostatic tachycardia (POTS) have included only a very small number of patients. In the current study, we report on the use of erythropoietin in patients with refractory POTS. The study was approved by the institutional review board. A retrospective nonrandomized analysis was performed on 39 patients evaluated at our autonomic center for POTS from 2003 to 2010. The diagnosis of POTS was based on patient history, physical examination, and response to head-up tilt-table testing. The mean follow-up period was 6 months. The patients were included in the current study if they had a diagnosis of POTS with severe symptoms of orthostatic intolerance and were refractory to the commonly used medications. All these patients were started on erythropoietin, and the response to therapy was considered successful if it provided symptomatic relief. We screened 200 patients with POTS and found 39 patients (age 33 ± 12, 37 females) to be eligible for inclusion in the current study. The response to the treatment was assessed subjectively in each patient and was obtained in a retrospective fashion from patient charts and physician communications. Eight (21%) patients demonstrated no improvement in symptoms after administration of erythropoietin. Three (8%) patients showed an improvement in symptoms of orthostatic intolerance of <3 months. Twenty-seven (71%) patients demonstrated sustained improvement in their symptoms of orthostatic intolerance at the mean follow-up of 6 months. Erythropoietin significantly improved sitting diastolic blood pressure but had no effect on other hemodynamic parameters. In a select group of POTS patients who are refractory to commonly used medications, erythropoietin may help improve symptoms of orthostatic intolerance.
authors.affiliation: Section of Electrophysiology, Division of Cardiology, Department of Medicine, Health Sciences Campus, The University of Toledo Medical Center, Toledo, OH 43614, USA.
authors.forename: Khalil
authors.initials: K
authors.lastname: Kanjwal
authors.forename: Bilal
authors.initials: B
authors.lastname: Saeed
authors.forename: Beverly
authors.initials: B
authors.lastname: Karabin
authors.forename: Yousuf
authors.initials: Y
authors.lastname: Kanjwal
authors.forename: Mujeeb
authors.initials: M
authors.lastname: Sheikh
authors.forename: Blair P
authors.initials: BP
authors.lastname: Grubb
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054972:Postural Orthostatic Tachycardia Syndrome / Q000188:drug therapy*; D012189:Retrospective Studies; D018667:Tilt-Table Test; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D004921:Erythropoietin