HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yukio Okazaki Satoshi Ohtsubo Masafumi Natsuaki Tsuyoshi Itoh Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rikitake, K. Articles by Itoh, T. Search for Related Content PubMed PubMed Citation Articles by Rikitake, K. Articles by Itoh, T. Related Collections Extracorporeal circulation

Eur J Cardiothorac Surg 2004;25:819-824
© 2004 Elsevier Science NL

Heparinless cardiopulmonary bypass with argatroban in dogs

Department of Thoracic and Cardiovascular Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga City, Saga 849-8501, Japan

Received 22 August 2002; received in revised form 15 December 2003; accepted 9 January 2004.

^* Corresponding author. Tel.: +81-952-34-2345; fax: +81-952-34-2061
e-mail: itoht2{at}post.saga-med.ac.jp

Objectives: Systemic heparinization is usually required for cardiopulmonary bypass (CPB). However, problems such as heparin-induced thrombocytopenia, protamine shock, and antithrombin III deficiency exist related to CPB with heparinization. The aim of this study was to evaluate argatroban (ARG) as a substitute for heparin during CPB. Methods: In the pilot study, blood samples were sequentially obtained from dogs with continuous infusion of ARG at a dose of 10 (n=6), 20 (n=6), or 30 (n=6) µg/kg per min for 2 h without CPB. In the main study, dogs underwent CPB for 2 h with 10 (n=6) or 30 (n=6) µg/kg per min of ARG or with heparin with blood samples obtained sequentially. Thrombogenicity in each group was evaluated by observation of the blood-contacting surfaces of the CPB circuits with scanning electron microscopy (SEM). Evidence of thromboembolism in the dogs was also investigated in histological specimens of the kidney and spleen in addition to microscopic observation at autopsy. Results: In the pilot study, the activated coagulation time (ACT) reached a maximum level dose-dependently after continuous infusion of ARG for 30 min. ACT returned to the baseline value within 60 min after the termination of continuous infusion. In the main study, CPB with 30 µg/kg per min of ARG achieved thrombin–antithrombin III complex (TAT) level similar to that achieved by CPB with heparin. Platelet count with 30 µg/kg per min of ARG tended to be higher than that with heparin or 10 µg/kg per min of ARG. The SEM appearance of blood-contacting surfaces of the CPB circuits after infusion with 30 µg/kg per min of ARG appeared to be similar to that after infusion with heparin. Depositions on the blood-contacting surfaces of the CPB circuits were also frequently observed with 10 µg/kg per min of ARG. Conclusions: Coagulability related to CPB was controlled by the appropriate ARG dosage without the use of heparin in dogs. ARG may be a substitute for heparin in CPB.

Key Words: Argatroban • Cardiopulmonary bypass • Coagulability • Scanning electron microscope