The direct thrombin inhibitor argatroban effectively prevents cardiac catheter thrombosis in vitro

Uwe Raaz; Anja Kaeberich; Lars Maegdefessel; Michael Buerke; Marese Busshardt; Sebastian Schubert; Martin Russ; Alexander Plehn; Henning Ebelt; Karl Werdan; Axel Schlitt

doi:10.1160/TH09-07-0456

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 103(04): 808-814
DOI: 10.1160/TH09-07-0456

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

The direct thrombin inhibitor argatroban effectively prevents cardiac catheter thrombosis in vitro

Authors

Uwe Raaz

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Anja Kaeberich

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Lars Maegdefessel

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Michael Buerke

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Marese Busshardt

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Sebastian Schubert

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Martin Russ

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Alexander Plehn

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Henning Ebelt

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Karl Werdan

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Axel Schlitt

¹Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany

Abstract

Summary

The direct thrombin inhibitor argatroban offers some significant advantages over unfractionated heparin (UFH) and is recommended as an alternative anticoagulant during percutaneous coronary interventions (PCI). The impact of argatroban on cardiac catheter thrombosis – a severe potential complication of PCI – has not been systematically studied yet. The aim of the present study was to test in vitro the hypothesis that argatroban is equivalent to the more established anticoagulants UFH and enoxaparin in preventing catheter thrombus formation. Blood pretreated with the anticoagulants of interest was continuously circulated through a guiding catheter by using a roller pump for a maximum experimental period of 60 minutes. In an alternate model, coagulation was mechanically induced by a magnetic stirrer. Coagulation parameters, overall thrombus weight and electron microscopic features (deposits of platelets and fibrin on the catheter surface) were quantified as endpoints. Argatroban (administered as bolus or continuous in-fusion), UFH (bolus), and enoxaparin (bolus) significantly reduced catheter thrombus formation compared to untreated controls. Here, neither overall thrombus weight nor platelet/fibrin deposition was different among the specific anticoagulants. Declining ACT (activated clotting time) levels – which were found in the argatroban bolus group – could be prevented by continuous infusion. In magnetic stirrer-induced coagulation, thrombus weight was lower following bolus treatment with UFH and enoxaparin compared to argatroban. These data suggest that the potential for argatroban in preventing catheter thrombosis is comparable to that of UFH and enoxaparin. However, the anticoagula-tory efficacy varied, depending on the model of coagulation activation, which demonstrates the necessity for specific testing.

Keywords

Anticoagulation - direct thrombin inhibitors - PCI

Full Text

References

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