Clinical application of argatroban as an alternative anticoagulant for extracorporeal circulation.

The authors attempted experimental and clinical use of argatroban as an alternative anticoagulant in left heart bypass with the centrifugal pump, percutaneous cardiopulmonary support (PCPS), and extracorporeal membrane oxygenation (ECMO) to determine if it has complementary effects in preventing thrombus formation without aggravating bleeding tendency. Its reversible binding to thrombin and its short half-life contributed to reduce the risk of excessive blood loss without clot formation within the extracorporeal circulation circuit during thoracic aortic surgery using left heart bypass. PCPS and ECMO were safely performed at doses ranging from 0.5 to 10 micrograms/kg/min to maintain activated clotting time at approximately 200 seconds. Although experimental studies showed argatroban to be advantageous in preserving platelet and fibrinogen, further clinical investigations are necessary.

[The left atrial-femoral bypass in operations on the descending aorta]. / Levopredserdno-bedrennyi obkhod pri operatsiiakh na niskhodiashchei aorte.

Fifteen patients were operated on for aortic aneurysms and were fitted with prostheses of the thoracoabdominal portion of the aorta in March 1997-February 1999. The operations were performed under conditions of a left atrial-femoral bypass with a centrifuge pump with a working heart. The patients were divided into 2 groups. In group 1 (10 pts), standard extracorporeal shunting and Cell-Saver were used, in group 2 (5 pts) the extracorporeal contour included an original system for rapid collection and return of autoblood. A left-atrial bypass prevented ischemia of the organs of the abdominal cavity and lower part of the body. Incorporation of a system for rapid collection and return of autoblood into the extracorporeal contour maintained stable hemodynamics, decreased heparin dose, preserved autoblood, and decreased the amount of transfused donor blood and its components.

Argatroban, an attractive anticoagulant, for left heart bypass with centrifugal pump for repair of traumatic aortic rupture.

Systemic heparinization often increases the risk of fatal bleeding from other injured organs in surgical repair of the aorta using extracorporeal circulation in patients with traumatic aortic rupture associated with multisystem injuries. We used an antithrombin agent, argatroban, as an alternative anticoagulant in left heart bypass with the Bio-Medicus centrifugal pump in 7 of 9 recent patients who underwent aortic repair using left heart bypass. All these patients survived without obvious evidence of systemic thromboembolization. Surgical treatments for other organ injuries were carried out in 3 patients concomitantly or immediately after aortic repairs without undue blood loss. Argatroban may have a complementary effect for preventing thrombus formation without aggravating bleeding tendency because of its monotarget specificity to thrombin. We believe intravenous administration (0.5 to 2 micrograms/kg/min) of argatroban is a safe anticoagulant for left heart bypass in repairs of traumatic aortic rupture associated with multiple organ injuries.