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Argatroban, an attractive anticoagulant, for left heart bypass with centrifugal pump for repair of traumatic aortic rupture

  • Tadanori Kawada
  • Yoshiharu Okada
  • Masayuki Hoson
  • Shinichi Endo
  • Motoyasu Yokoyama
  • Yosuke Kitanaka
  • Kanako Kimura
  • Hiroyuki Abe
  • Noboru Yamate
Original Article

Abstract

Systemic heparinization often increases the risk of fatal bleeding from other injured organs in surgical repair of the aorta using extracorporeal circulation in patients with traumatic aortic rupture associated with multisystem injuries. We used an antithrombin agent, argatroban, as an alternative anticoagulant in left heart bypass with the Bio-Medicus centrifugal pump in 7 of 9 recent patients who underwent aortic repair using left heart bypass. All these patients survived without obvious evidence of systemic thromboembolization. Surgical treatments for other organ injuries were carried out in 3 patients concomitantly or immediately after aortic repairs without undue blood loss. Argatroban may have a complementary effect for preventing thrombus formation without aggravating bleeding tendency because of its monotarget specificity to thrombin. We believe intravenous administration (0.5 to 2 μg/kg/min) of argatroban is a safe anticoagulant for left heart bypass in repairs of traumatic aortic rupture associated with multiple organ injuries.

Index words

Argatroban traumatic aortic rupture left heart bypass Bio-Medicus centrifugal pump 

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References

  1. 1.
    Olivier HF Jr, Maher TD, Liebler GA, Park SB, Burkholder JA, Magovern GJ. Use of the BioMedicus centrifugal pump in traumatic tears of the thoracic aorta. Ann Thorac Surg 1984; 38: 586–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Hess PJ, Howe HR Jr, Robicsek F, Daugherty HK, Cook JW, Selle JG, et al. Traumatic tears of the thoracic aorta: improved results using the Bio-Medicus pump. Ann Thorac Surg 1987; 48: 6–9.CrossRefGoogle Scholar
  3. 3.
    Kawada T, Mieda T, Hoson M, Koyama T, Abe H, Funaki S, et al. Left heart bypass with the Bio-Medicus centrifugal pump: the use of argatroban for preventing platelet loss. Artif Organs Today 1992; 2: 177–84.Google Scholar
  4. 4.
    Okamaoto S, Hijikata A, Kikumoto R, Tonomura S, Hara H, Ninomiya K, et al. Potent inhibition of thrombin by the newly synthesized arginine derivative, No 805: The importance of stereostructure of its hydrophobic carboxamide portion. Biochem Biophys Res Commun 1981; 101: 440–6.CrossRefGoogle Scholar
  5. 5.
    Akins CW, Buckley MJ, Daggett W, McIlduff JB, Austen WG. Acute traumatic disruption of the thoracic aorta: a ten-year experience. Ann Thorac Surg 1981; 31: 305–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Soots G, Warembourg H Jr, Prat A, Roux JP. Acute traumatic rupture of the thoracic aorta: place of delayed surgical repair. J Cardiovasc Surg 1989; 30: 173–7.Google Scholar
  7. 7.
    Mattox KL, Holzman M, Pickard R, Beall AC Jr, DeBakey ME. Clamp/repair: a safe technique for treatment of blunt injury to the descending thoracic aorta. Ann Thorac Surg 1985; 40: 456–63.PubMedCrossRefGoogle Scholar
  8. 8.
    Dixon CM, Magovern J. Evaluation of the Bio-Pump for long-term cardiac support without heparinization. J Extracorp Technol 1982; 14: 331–6.Google Scholar
  9. 9.
    Lefkovits J, Topol EJ. Direct thrombin inhibitors in cardiovascular medicine. Circulation 1994; 90: 1522–36.PubMedGoogle Scholar
  10. 10.
    Sugawara H, Kumon K, Tanaka K, Esato Y, Naitou Y, Fujita T. Evaluation of a synthetic thrombin inhibitor MD 805 as anticoagulant after open heart and vascular surgery. Jpn J Thorac Surg 1983; 36: 533–7.Google Scholar
  11. 11.
    Fukutake K, Tateyama M, Amano K, Ueda M, Fujimaki M. Clinical pharmacology of argatroban, selective antithrombin agent: comparative study with heparin. Cardioangiology 1991; 29: 190–6.Google Scholar
  12. 12.
    Williams JS, Graff JA, Uke JM, Steinig JP. Aortic injury in vehicular trauma. Ann Thorac Surg 1994; 57: 726–30.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Thoracic and Cadiovascular Surgery 1999

Authors and Affiliations

  • Tadanori Kawada
    • 1
  • Yoshiharu Okada
    • 2
  • Masayuki Hoson
    • 2
  • Shinichi Endo
    • 2
  • Motoyasu Yokoyama
    • 2
  • Yosuke Kitanaka
    • 2
  • Kanako Kimura
    • 2
  • Hiroyuki Abe
    • 2
  • Noboru Yamate
    • 2
  1. 1.First Department of SurgeryShowa University School of MedicineTokyoJapan
  2. 2.Division of Cardiovascular Surgery, Third Department of SurgerySt. Marianna University School of MedicineKanagawaJapan

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