PMID- 19492162
OWN - NLM
STAT- MEDLINE
DCOM- 20100917
LR  - 20201209
IS  - 0340-6245 (Print)
IS  - 0340-6245 (Linking)
VI  - 101
IP  - 6
DP  - 2009 Jun
TI  - Argatroban and bivalirudin compared to unfractionated heparin in preventing 
      thrombus formation on mechanical heart valves. Results of an in-vitro study.
PG  - 1163-9
AB  - 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.
FAU - Maegdefessel, Lars
AU  - Maegdefessel L
AD  - Department of Internal Medicine III, Martin Luther-University, Ernst-Grube-Str. 
      40, 06097 Halle, Germany. lars.maegdefessel@medizin.uni-halle.de
FAU - Linde, Torsten
AU  - Linde T
FAU - Michel, Thomas
AU  - Michel T
FAU - Hamilton, Kathrin
AU  - Hamilton K
FAU - Steinseifer, Ulrich
AU  - Steinseifer U
FAU - Friedrich, Ivar
AU  - Friedrich I
FAU - Schubert, Sebastian
AU  - Schubert S
FAU - Hauroeder, Baerbel
AU  - Hauroeder B
FAU - Raaz, Uwe
AU  - Raaz U
FAU - Buerke, Michael
AU  - Buerke M
FAU - Werdan, Karl
AU  - Werdan K
FAU - Schlitt, Axel
AU  - Schlitt A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Pipecolic Acids)
RN  - 0 (Recombinant Proteins)
RN  - 0 (Sulfonamides)
RN  - 9005-49-6 (Heparin)
RN  - 94ZLA3W45F (Arginine)
RN  - EC 3.4.21.5 (Thrombin)
RN  - IY90U61Z3S (argatroban)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Arginine/analogs & derivatives
MH  - Diagnostic Techniques, Cardiovascular/instrumentation
MH  - Drug Therapy, Combination
MH  - Feasibility Studies
MH  - Heart Diseases/*drug therapy/surgery
MH  - Heart-Assist Devices
MH  - Heparin/*administration & dosage/adverse effects
MH  - Hirudins/*administration & dosage/adverse effects
MH  - Humans
MH  - In Vitro Techniques
MH  - Infusion Pumps
MH  - Male
MH  - Peptide Fragments/*administration & dosage/adverse effects
MH  - Pipecolic Acids/*administration & dosage/adverse effects
MH  - Recombinant Proteins/administration & dosage/adverse effects
MH  - Sulfonamides
MH  - Thrombin/analysis
MH  - Thrombocytopenia/chemically induced/prevention & control
MH  - Thrombosis/prevention & control
EDAT- 2009/06/06 09:00
MHDA- 2010/09/21 06:00
CRDT- 2009/06/04 09:00
PHST- 2009/06/04 09:00 [entrez]
PHST- 2009/06/06 09:00 [pubmed]
PHST- 2010/09/21 06:00 [medline]
AID - 09061163 [pii]
PST - ppublish
SO  - Thromb Haemost. 2009 Jun;101(6):1163-9.