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European Journal of Cardio-Thoracic Surgery, Vol 11, 739-745, Copyright © 1997 by European Association for Cardio-thoracic Surgery

ARTICLES

Recombinant hirudin as an anticoagulant during cardiac operations: experiments in a pig model

FC Riess, B Potzsch, I Behr, K Jager, R Rossing, N Bleese, W Schaper and G Muller- Berghaus
Division of Thoracic and Cardiovascular Surgery, Kerckhoff-Klinik, Max- Planck-Institut fur physiologische, Bad Nauheim, Germany.

OBJECTIVE: The efficacy and safety of recombinant hirudin (r-hirudin) compared with heparin as an anticoagulant during open-heart surgery has been studied in a pig model. METHODS: A total of 18 Gottingen minipigs were randomly divided into three treatment groups and subjected to cardiopulmonary bypass for 1 h. Heparin-treated animals received a bolus of unfractionated heparin of 400 IU/kg body weight. Recombinant hirudin was given by a bolus injection of 1 mg/kg body weight, followed by a 1 h lasting infusion of 1 mg/kg body weight per h. The heparin- anticoagulated animals and one group of the hirudin-treated animals additionally received aprotinin at a dosage of 17500 KIU/kg body weight (KIU, kallikrein inhibitory units). In the second group of r-hirudin- treated animals, the aprotinin was replaced by saline. RESULTS: The extracorporeal circuit remained patent for a 1 h pump period in all of the animals studied. There was no evidence of vascular occlusion or clot formation in the r-hirudin-treated animals. The anticoagulant efficacy of the hirudin protocol used is further demonstrated by the results of electron-microscopical scans of the pump-line filters. Fibrin deposits were visible only in the heparin-treated animals and not in r-hirudin-treated pigs. Despite this strong anticoagulant effect, there was no evidence of an increased bleeding tendency in r- hirudin-treated pigs. Moreover, histological studies showed a statistically significant (P < 0.05) higher incidence of tissue bleeding in the heparin/aprotinin-treated animals compared with the r- hirudin/aprotinin-treated pigs. Studying the platelet function, a statistically significant (P < 0.01) better preserved ADP- and collagen- induced platelet aggregation was seen in the r-hirudin/aprotinin- treated animals when compared with heparin/aprotinin-treated animals. CONCLUSIONS: These data demonstrate that r-hirudin can be used successfully as an alternative anticoagulant to heparin during cardiac operations including cardiopulmonary bypass. The better preservation of platelet function suggests that r-hirudin may reduce the postoperative risk of bleeding.

This article has been cited by other articles:

				S. Beholz, H. Grubitzsch, B. Bergmann, H.-G. Wollert, and L. Eckel Anticoagulation in extracorporeal circulation using recombinant hirudin: a case report Perfusion, May 1, 2000; 15(3): 257 - 260. [Abstract] [PDF]