Document Detail

Argatroban as a substitute of heparin during cardiopulmonary bypass: a safe alternative?
MedLine Citation:
PMID:  20061338     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The patient with a diagnosis of heparin-induced thrombocytopenia and thrombosis who requires urgent cardiac surgery represents a formidable challenge. Among the alternatives to heparin, argatroban has gained widespread use in non-cardiac surgery patients. The object of this communication is to report our recent experience with this agent during cardiopulmonary bypass (CPB) and to review the cases previously published in order to better define indications, dosage, monitoring and limitations in cardiac surgery patients. METHODS: A case of mitral valve replacement where argatroban was used for anticoagulation during CPB is described. The literature on the subject is reviewed and the relationship between argatroban dosage and activated clotting time (ACT) is studied by regression analysis. RESULTS: Clotting of the oxygenator requiring prompt replacement occurred after release of cross-clamp. Upon termination of the drug, ACT remained elevated beyond the expected half-life. A significative (P<0.05) relationship was disclosed between increasing dosage and ACT, while the same relationship was absent on decreasing dosage. CONCLUSIONS: Because of unresolved issues like the possibility of clotting in the extracorporeal circuit and prolonged anticoagulation after discontinuing the drug, at present, the use of argatroban as a substitute of heparin during CPB should be restricted to those cases where the other thrombin inhibitors are contraindicated.
Fabrizio Follis; Gianfranco Filippone; Giuseppe Montalbano; Maria Floriano; Ettore Lobianco; Giuseppe D'Ancona; Marco Follis
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2010-01-08
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  10     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-25     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  592-6     Citation Subset:  IM    
Department of Cardiac Surgery, ARNAS, Palermo, Italy.
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MeSH Terms
Aged, 80 and over
Anticoagulants / administration & dosage*,  adverse effects*,  pharmacokinetics
Blood Coagulation / drug effects*
Cardiopulmonary Bypass* / adverse effects
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Monitoring
Heart Valve Prosthesis Implantation
Heparin / adverse effects*
Infant, Newborn
Infusions, Intravenous
Middle Aged
Pipecolic Acids / administration & dosage*,  adverse effects,  pharmacokinetics
Postoperative Hemorrhage / blood,  chemically induced
Risk Assessment
Thrombin / antagonists & inhibitors
Thrombocytopenia / chemically induced*,  prevention & control
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Pipecolic Acids; 74863-84-6/argatroban; 9005-49-6/Heparin; EC

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