Argatroban and bivalirudin compared to unfractionated heparin in preventing thrombus formation on mechanical heart valves

Lars Maegdefessel; Torsten Linde; Thomas Michel; Kathrin Hamilton; Ulrich Steinseifer; Ivar Friedrich; Sebastian Schubert; Baerbel Hauroeder; Uwe Raaz; Michael Buerke; Karl Werdan; Axel Schlitt

doi:10.1160/TH08-09-0571

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 101(06): 1163-1169
DOI: 10.1160/TH08-09-0571

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Argatroban and bivalirudin compared to unfractionated heparin in preventing thrombus formation on mechanical heart valves

Results of an in-vitro study

Authors

Lars Maegdefessel

¹Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
Torsten Linde

²Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
Thomas Michel

¹Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
Kathrin Hamilton

²Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
Ulrich Steinseifer

²Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
Ivar Friedrich

³Department of Cardiovascular Surgery at the Martin Luther-University Hospital Halle-Wittenberg, Germany
Sebastian Schubert

¹Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
Baerbel Hauroeder

⁴Central Institute of the German Federal Armed Forces, Koblenz, Germany
Uwe Raaz

¹Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
Michael Buerke

¹Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
Karl Werdan

¹Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
Axel Schlitt

¹Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany

Abstract

Summary

Prevention of valve thrombosis in patients after prosthetic mechanical heart valve replacement and heparin-induced thrombocytopenia (HIT) is still an open issue. The aim of the present in-vitro study was to investigate the efficacy of argatroban and bivalirudin in comparison to unfractionated heparin (UFH) in preventing thrombus formation on mechanical heart valves. Blood (230 ml) from healthy young male volunteers was anticoagulated either by UFH, argatroban bolus, argatroban bolus plus continuous infusion, bivalirudin bolus, or bivalirudin bolus plus continuous infusion. Valve prostheses were placed in a newly developed in-vitro thrombosis tester and exposed to the anticoagulated blood samples. To quantify the thrombi, electron microscopy was performed, and each valve was weighed before and after the experiment. Mean thrombus weight in group 1 (UFH) was 117 + 93 mg, in group 2 (argatroban bolus) 722 + 428 mg, in group 3 (bivalirudin bolus) 758 + 323 mg, in group 4 (argatroban bolus plus continuous infusion) 162 + 98 mg, and in group 5 (bivalirudin bolus plus continuous infusion) 166 + 141 mg (p-value <0.001). Electron microscopy showed increased rates of thrombus formation in groups 2 and 3. Argatroban and bivalirudin were as effective as UFH in preventing thrombus formation on valve prostheses in our in-vitro investigation when they were administered continuously. We hypothesise that continuous infusion of argatroban or bivalirudin are optimal treatment options for patients with HIT after mechanical heart valve replacement for adapting oral to parenteral anticoagulation or vice versa.

Keywords

Heart valve thrombosis - anticoagulation - argatroban - bivalirudin - unfractionated heparin

Full Text

References

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