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VIP Contraindications: Clinical Comparison Table
Baseline hypotension (SBP <100 mmHg) VIP-induced vasodilation drops MAP by 15–25%, risking cerebral hypoperfusion Absolute Resting BP in supine and standing positions, orthostatic vital signs Exclude unless continuous hemodynamic monitoring available. Syncope
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- Baseline hypotension (SBP <100 mmHg)
- VIP-induced vasodilation drops MAP by 15–25%, risking cerebral hypoperfusion
- Absolute
- Resting BP in supine and standing positions, orthostatic vital signs
- Exclude unless continuous hemodynamic monitoring available. Syncope risk unacceptable in outpatient research
- Active malignancy (VPAC+ tumors)
- VIP acts as growth factor via MAPK/ERK and PI3K/Akt signaling; stimulates angiogenesis and proliferation
- Plasma VIP level, chromogranin A, cross-sectional imaging, tumor marker panel
- Any active disease or remission <5 years requires oncology clearance and receptor profiling before enrollment
- Uncontrolled bleeding disorder or anticoagulation
- VIP inhibits platelet aggregation via cAMP elevation; extends bleeding time 20–35%
- Absolute if INR >1.5 or plt <100k
- CBC with platelet count, PT/INR, bleeding history questionnaire
- Concurrent anticoagulant or antiplatelet therapy is exclusion unless protocol includes hemorrhage monitoring
- CHF with reduced EF (<40%)
- Afterload reduction without inotropic support drops cardiac output; triggers reflex tachycardia
- Relative
- Echocardiogram, BNP or NT-proBNP, NYHA class assessment
- Requires invasive hemodynamic monitoring (PA catheter); exclude if outpatient setting without ICU-level support
- Orthostatic intolerance (POTS, autonomic failure)
- VIP reduces sympathetic tone and pools blood in splanchnic bed; impairs compensatory baroreceptor response
- Tilt table test or standing vitals with HR/BP at 1, 3, 5, 10 min
- ΔHR ≥30 bpm or ΔSBP ≥20 mmHg qualifies as exclusion. Presyncope documented in multiple case reports
- History of VIPoma or secretory diarrhea syndrome
- Exogenous VIP amplifies endogenous hypersecretion; worsens electrolyte derangement (K+, HCO3−)
- Fasting plasma VIP, stool volume/electrolyte panel, chromogranin A
- Plasma VIP >200 pg/mL or unexplained chronic diarrhea (>1L/day) requires endocrine workup before clearance