Objective
To evaluate the efficacy and safety of tolvaptan in fluid management after cardiac surgery compared with conventional diuretic treatment.
Design
Systematic review of the literature with meta-analyses.
Setting
The Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar databases were searched from inception to July 30, 2018.
Participants
The study comprised 759 patients undergoing cardiac surgery.
Interventions
Tolvaptan administration (n = 397) or standard diuretic therapy (n = 398).
Measurements and Main Results
Ten studies were included in the present meta-analysis. Tolvaptan administration was associated with a significantly faster return to preoperative body weight (mean difference [MD)] –1.48 d, 95% confidence interval [CI] –1.92 to 1.03), shorter duration of hospital stay (MD –2.58 d, 95% CI –5.09 to –0.07), lower incidence of acute kidney injury (odds ratio 0.34, 95% CI 0.16-0.69), and greater urine output (MD 0.47 L/d, 95% CI 0.25-0.69) and sodium levels (MD 2.85 mEq/L, 95% CI 1.90-3.80). No significant differences were present regarding duration of intensive care unit stay (MD –0.09 d, 95% CI –0.33 to 0.15), arrhythmia incidence (odds ratio 0.58, 95% CI 0.33-1.02), and serum creatinine values (MD –0.08 mg/dL, 95% CI –0.20 to 0.04).
Conclusions
The outcomes of the present meta-analysis suggest the promising role of tolvaptan administration in the management of fluid retention in patients after cardiac surgery. Future large-scale clinical trials should be conducted to fully elucidate its efficacy and to assess the optimal treatment protocol to be applied in the clinical setting.