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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
Lars Maegdefessel
1   Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
,
Torsten Linde
2   Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
,
Thomas Michel
1   Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
,
Kathrin Hamilton
2   Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
,
Ulrich Steinseifer
2   Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
,
Ivar Friedrich
3   Department of Cardiovascular Surgery at the Martin Luther-University Hospital Halle-Wittenberg, Germany
,
Sebastian Schubert
1   Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
,
Baerbel Hauroeder
4   Central Institute of the German Federal Armed Forces, Koblenz, Germany
,
Uwe Raaz
1   Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
,
Michael Buerke
1   Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
,
Karl Werdan
1   Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
,
Axel Schlitt
1   Department of Internal Medicine III at the Martin Luther-University Hospital Halle-Wittenberg, Germany
› Author Affiliations
Further Information

Publication History

Received: 04 September 2008

Accepted after minor revision: 24 February 2009

Publication Date:
24 November 2017 (online)

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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
 

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