PMID- 18480673
OWN - NLM
STAT- MEDLINE
DCOM- 20081007
LR  - 20181201
IS  - 0954-6928 (Print)
IS  - 0954-6928 (Linking)
VI  - 19
IP  - 4
DP  - 2008 Jun
TI  - In-vitro comparison of fondaparinux, unfractionated heparin, and enoxaparin in 
      preventing cardiac catheter-associated thrombus.
PG  - 279-84
LID - 10.1097/MCA.0b013e328300426b [doi]
AB  - BACKGROUND: The Organization to Assess Strategies in Acute Ischemic Syndromes 
      trials showed that fondaparinux (fonda) is at least as effective and safe as 
      unfractionated heparin (UFH) and enoxaparin (enoxa) in acute coronary syndromes. 
      Unexpectedly, there was an increase in catheter-related thrombus formation during 
      percutaneous coronary interventions in fonda-treated patients. METHODS: Ten 
      healthy male volunteers were pretreated with aspirin 500 mg 2 h before 
      venesection of 50 ml of blood. Eight groups of anticoagulant (combinations) were 
      tested and volunteers donated blood eight times, thus, acting as their own 
      controls. The groups were UFH, UFH+eptifibatide, enoxa, enoxa+eptifibatide, 
      fonda, fonda+eptifibatide, fonda+(half-therapeutic) UFH, and 
      fonda+eptifibatide+(half-therapeutic) UFH. The blood/anticoagulant mix was kept 
      at 37 degrees C and continuously circulated through a guiding catheter for 60 min 
      or until the catheter became blocked with thrombus. Thrombus development was 
      assessed by weighing each catheter before and after the procedure. Electron 
      microscopy of the catheter lining was used to quantify the degree of erythrocyte 
      and fibrin deposition. RESULTS: Despite fonda anticoagulation, catheters were 
      invariably occluded by thrombus before the 60 min perfusion period had elapsed. 
      Thrombotic catheter occlusion occurred even with higher fonda concentrations and 
      combined fonda/eptifibatide use. All other combinations (including fonda and 
      half-therapeutic UFH) ensured catheter patency for 60 min. Furthermore, thrombus 
      weight and the cell/fibrinogen counts were significantly increased in fonda and 
      fonda+eptifibatide compared with other treatment groups. CONCLUSION: Treatment 
      with fonda, even in combination with eptifibatide, was not sufficient to prevent 
      cardiac catheter thrombus development in our in-vitro study. However, the 
      combination of fonda with 'half' therapeutic dosages of UFH were as efficient as 
      other treatment strategies in preventing thrombus formation.
FAU - Schlitt, Axel
AU  - Schlitt A
AD  - Department of Medicine III, Martin Luther-University Halle-Wittenberg, 
      Halle-Wittenberg, Germany. axel.schlitt@medizin.uni-halle.de
FAU - Rupprecht, Hans J
AU  - Rupprecht HJ
FAU - Reindl, Iris
AU  - Reindl I
FAU - Schubert, Sebastian
AU  - Schubert S
FAU - Hauroeder, Baerbel
AU  - Hauroeder B
FAU - Carter, Justin M
AU  - Carter JM
FAU - Peetz, Dirk
AU  - Peetz D
FAU - Kropff, Stefan S
AU  - Kropff SS
FAU - Maegdefessel, Lars
AU  - Maegdefessel L
FAU - Russ, Martin
AU  - Russ M
FAU - Schmidt, Hendrik
AU  - Schmidt H
FAU - Ebelt, Henning
AU  - Ebelt H
FAU - Werdan, Karl
AU  - Werdan K
FAU - Buerke, Michael
AU  - Buerke M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Coron Artery Dis
JT  - Coronary artery disease
JID - 9011445
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Cardiac Catheterization/*drug effects
MH  - Enoxaparin/pharmacology
MH  - Fibrinolytic Agents/*pharmacology
MH  - Fondaparinux
MH  - Heparin/pharmacology
MH  - Humans
MH  - In Vitro Techniques
MH  - Male
MH  - Microscopy, Electron
MH  - Polysaccharides/pharmacology
MH  - Thrombosis/*prevention & control
EDAT- 2008/05/16 09:00
MHDA- 2008/10/08 09:00
CRDT- 2008/05/16 09:00
PHST- 2008/05/16 09:00 [pubmed]
PHST- 2008/10/08 09:00 [medline]
PHST- 2008/05/16 09:00 [entrez]
AID - 00019501-200806000-00010 [pii]
AID - 10.1097/MCA.0b013e328300426b [doi]
PST - ppublish
SO  - Coron Artery Dis. 2008 Jun;19(4):279-84. doi: 10.1097/MCA.0b013e328300426b.