Argatroban for Percutaneous Coronary Interventions

Omer Iqbal; Cafer Adiguzel; Bruce E. Lewis; Josephine Cunanan; Jawed Fareed

doi:10.1055/s-0028-1086084

Seminars in Thrombosis and Hemostasis, Inhaltsverzeichnis

Semin Thromb Hemost 2008; 34: 062-074
DOI: 10.1055/s-0028-1086084

Argatroban for Percutaneous Coronary Interventions

Omer Iqbal¹ , Cafer Adiguzel¹ , Bruce E. Lewis¹ , Josephine Cunanan¹ , Jawed Fareed¹

¹Loyola University Chicago, Maywood, Illinois

Abstract

ABSTRACT

Concomitant anticoagulant therapy is essential in patients undergoing percutaneous coronary interventions (PCI) to achieve prompt, early, complete, and sustained coronary artery recanalization. Heparin has been historically used in these procedures. Argatroban is a small-molecule, synthetic, reversible direct thrombin inhibitor. It has a predictable anticoagulant response and also the potential to inhibit clot-bound thrombin. The accessibility of argatroban to the active site of clot-bound thrombin is an advantage for the treatment of coronary occlusion. This is accomplished by virtue of the low molecular weight of argatroban (527 Da). Argatroban has been shown in clinical studies to be a safe and effective anticoagulant during PCI. It has received approval from the Food and Drug Administration for anticoagulation in patients with heparin-induced thrombocytopenia who require PCI. Other clinical studies have shown that argatroban, combined with the GP (glycoprotein) IIb/IIIa receptor inhibitors, can also be successfully used for anticoagulation in coronary interventional procedures. Clinical trials in the setting of PCI and related coronary interventional procedures are ongoing.

KEYWORDS

Antithrombin - argatroban - coronary intervention - recanalization - heparin-induced thrombocytopenia (HIT)

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Referenzen

REFERENCES

1 Herrick J B. Clinical features of sudden obstruction of the coronary arteries. JAMA 1912;59:2015–2019. JAMA. 1983; 250 1757-1765
2 DeWood M A, Spores J, Notske R et al.. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980; 303(16) 897-902
3 Reimer K A, Lowe J E, Rasmussen M M, Jennings R B. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs. duration of coronary occlusion in dogs. Circulation. 1977; 56(5) 786-794
4 The Thrombolysis in Myocardial Infarction (TIMI) trial . Phase 1 findings. TIMI Study Group. N Engl J Med. 1985; 312(14) 932-936
5 Verstraete M, Bernard R, Bory M et al.. Randomized trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Report from the European Cooperative Study Group for Recombinant Tissue-type Plasminogen Activator. Lancet. 1985; 1 842-847
6 An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators. N Engl J Med. 1993; 329(10) 673-682
7 Puma J A, Sketch Jr M H, Thompson T D et al.. Support for the open artery hypothesis in survivors of acute myocardial infarction: analysis of 11,228 patients treated with thrombolytic therapy. Am J Cardiol. 1999; 83(4) 482-487
8 Reiner J S, Lundergan C F, van den Brand M et al.. Early angiography cannot predict postthrombolytic coronary reocclusion: observations from the GUSTO angiographic study. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries. J Am Coll Cardiol. 1994; 24(6) 1439-1444
9 Hoffmeister H M, Kastner C, Szabo S et al.. Fibrin specificity and procoagulant effect related to the kallikrein-contact phase system and to plasmin generation with double-bolus reteplase and front-loaded alteplase thrombolysis in acute myocardial infarction. Am J Cardiol. 2000; 86(3) 263-268
10 Barbagelata N A, Granger C B, Oqueli E et al.. TIMI grade 3 flow and reocclusion after intravenous thrombolytic therapy: a pooled analysis. Am Heart J. 1997; 133(3) 273-282
11 Colman R, Clowes A, James G. Overview of hemostasis. In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN Hemostasis and thrombosis: basic principles and clinical practice. 4th ed. Philadelphia, PA; Lippincott Williams & Wilkins 2000: 3-16
12 Loewy A G, McDonagh J, Mikkola H, Teller D C, Yee V C. Structure and function of factor XIII. In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN Hemostasis and thrombosis: basic principles of clinical practice. 4th ed. Philadelphia, PA; Lippincott Williams & Wilkins 2000: 233-236
13 Coughlin S R. Thrombin signaling and protease-activated receptors. Nature. 2000; 407(6801) 258-264
14 Libby P, Simon D. Thrombin and atherosclerosis. In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN Hemostasis and thrombosis: basic principles and clinical practice. 4th ed. Philadelphia, PA; Lippincott Williams & Wilkins 2000: 743-752
15 Turpie A G, Antman E M. Low-molecular-weight heparins in the treatment of acute coronary syndromes. Arch Intern Med. 2001; 161(12) 1484-1490
16 Wallentin L, Dellborg D M, Lindahl B, Nilsson T, Pehrsson K, Swahn E. The low-molecular-weight heparin dalteparin as adjuvant therapy in acute myocardial infarction: the ASSENT PLUS study. Clin Cardiol. 2001; 24(Suppl 3) I12-I14
17 Ross A M, Molhoek P, Lundergan C et al.. Randomized comparison of enoxaparin, a low-molecular-weight heparin, with unfractionated heparin adjunctive to recombinant tissue plasminogen activator thrombolysis and aspirin: second trial of Heparin and Aspirin Reperfusion Therapy (HART II). Circulation. 2001; 104(6) 648-652
18 Coulter S A, Cannon C P, Ault K A et al.. High levels of platelet inhibition with abciximab despite heightened platelet activation and aggregation during thrombolysis for acute myocardial infarction: results from TIMI (thrombolysis in myocardial infarction) 14. Circulation. 2000; 101(23) 2690-2695
19 Bertram U, Moser M, Peter K et al.. Effects of different thrombolytic treatment regimen with abciximab and tirofiban on platelet aggregation and platelet-leukocyte interactions: a subgroup analysis from the GUSTO V and FASTER trials. J Thromb Thrombolysis. 2002; 14(3) 197-203
20 Weaver W D, Simes R J, Betriu A et al.. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA. 1997; 278(23) 2093-2098 , [erratum appears in JAMA 1998;279(23):1876]
21 American Heart Association .Heart and stroke statistical update. Dallas, TX; American Heart Association 2001 http://www.americanheart.org Accessed June 13, 2008
22 Montalescot G, Barragan P, Wittenberg O et al.. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med. 2001; 344(25) 1895-1903
23 Fareed J, Callas D, Hoppensteadt D A, Lewis B E, Bick R L, Walenga J M. Antithrombin agents as anticoagulants and antithrombotics: implications in drug development. Semin Hematol. 1999; 36(1, suppl 1) 42-56
24 Fareed J, Lewis B E, Callas D D, Hoppensteadt D A, Walenga J M, Bick R L. Antithrombin agents: the new class of antithrombotic drugs. Clin Appl Thromb Hemost. 1999; 5(Suppl 1) S45-S55
25 Iqbal O, Lewis B E, Ahmad S, Hoppensteadt D A, Fareed J. Dosage adjustment of antithrombin drugs justified in combination with abciximab: laboratory and clinical implications. In: Proceedings of the 14th Congress of European Chapter of the International Union of Angiology, Cologne, Germany: Monduzzi Editore, International Proceedings Division, Bologna, Italy 2001: 551-554
26 Fitzgerald D, Murphy N. Argatroban: a synthetic thrombin inhibitor of low relative molecular mass. Coron Artery Dis. 1996; 7(6) 455-458
27 Kikumoto R, Tamao Y, Ohkubo K et al.. Thrombin inhibitors: 2-amide derivatives of N alpha-substituted L-arginine. J Med Chem. 1980; 23(8) 830-836
28 Okamoto S, Hijikata A, Kikumoto R et al.. Potent inhibition of thrombin by the newly synthesized arginine derivative No 805. The importance of stereo-structure of its hydrophobic carboxamide portion. Biochem Biophys Res Commun. 1981; 101(2) 440-446
29 Lewis B E, Iaffaldano R, McKiernan T L, Rao L, Donkin J, Walenga J M. Report of a successful use of argatroban as an alternative anticoagulant during coronary stent implantation in a patient with heparin-induced thrombocytopenia and thrombosis syndrome. Cathet Cardiovasc Diagn. 1996; 38(2) 206-209
30 Hijikata A, Okamoto S, Mori E, Kinjo K, Kikumoto R. In vitro and in vivo studies of a new series of synthetic thrombin inhibitors (OM-inhibitors). Thromb Res. 1976; 8(Suppl 2) 83-89
31 Hursting M J, Alford K L, Becker J C et al.. Novastan (brand of argatroban): a small-molecule, direct thrombin inhibitor. Semin Thromb Hemost. 1997; 23(6) 503-516
32 Lewis B E, Matthai Jr W H, Cohen M, Moses J W, Hursting M J, Leya F. for the ARG-216/310/311 Study Investigators. Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin induced thrombocytopenia. Catheter Cardiovasc Interv. 2002; 57 177-184
33 Roessig L, Genth-Zotz S, Rau M et al.. Argatroban anticoagulation for PCI: The E04 European Multi-Center Study. Circulation. 2007; 116(II) 617-618 , [abstract]
34 Jang I K, Lewis B E, Matthai Jr W H, Kleiman N S. Argatroban anticoagulation in conjunction with glycoprotein IIb/IIIa inhibition in patients undergoing percutaneous coronary intervention: an open-label, non-randomized trial. J Thromb Thrombolysis. 2004; 18(1) 31-37
35 Cox D S, Kleiman N S, Boyle D A et al.. Pharmacokinetics and pharmacodynamics of argatroban in combination with a platelet glycoprotein IIb/IIIa receptor antagonist in patients undergoing percutaneous coronary intervention. J Clin Pharmacol. 2004; 44(9) 981-990
36 Hirahara T, Kubo N, Ohmura N et al.. Prospective randomized study of argatroban versus heparin anticoagulation therapy after percutaneous coronary intervention for acute myocardial infarction. J Cardiol. 2004; 44(2) 47-52
37 Itoh T, Nonogi H, Miyazaki S et al.. Local delivery of argatroban for the prevention of restenosis after coronary balloon angioplasty: a prospective randomized pilot study. Circ J. 2004; 68(7) 615-622
38 Vermeer F, Vahanian A, Fels P W et al.. Argatroban and alteplase in patients with acute myocardial infarction: the ARGAMI study. J Thromb Thrombolysis. 2000; 10(3) 233-240
39 Baron S J, Yeh R W, Cruz-Gonzalez I et al.. Efficacy and safety of argatroban in patients with heparin-induced thrombocytopenia undergoing endovascular intervention for peripheral arterial disease. Catheter Cardiovasc Interv. 2008; 19(5) 401-404
40 Walenga J M, Fasanella A R, Iqbal O et al.. Coagulation laboratory testing in patients treated with argatroban. Semin Thromb Hemost. 1999; 25(suppl 1) 61-66
41 Lewis B E, Grassman E D, Wrona L, Rangel Y. Novastan anticoagulation during renal stent implant in a patient with heparin-induced thrombocytopenia. Blood Coagul Fibrinolysis. 1997; 8(1) 54-58
42 Kondo L M, Wittkowsky A K, Wiggins B S. Argatroban for prevention and treatment of thromboembolism in heparin-induced thrombocytopenia. Ann Pharmacother. 2001; 35(4) 440-451
43 Iqbal O, Ahmad S, Lewis B E, Walenga J M, Rangel Y, Fareed J. Monitoring of argatroban in ARG310 Study: Potential recommendations for its use in interventional cardiology. Clin Appl Thromb Hemost. 2002; 8(3) 217-224

Omer IqbalM.D.

Department of Pathology, Hemostasis Research Laboratories, Building 102

Room 2646, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL 60153

eMail: oiqbal@lumc.edu