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Original Articles: Adult Cardiac

Argatroban as a Primary or Secondary Postoperative Anticoagulant in Patients Implanted With Ventricular Assist Devices

Department of Cardiothoracic Surgery, Lankenau Hospital, Wynnewood, Pennsylvania

Accepted for publication January 28, 2008.

^_* Address correspondence to Dr Samuels, Lankenau Hospital, Department of Cardiothoracic Surgery, MSB Suite 280, 100 Lancaster Ave, Wynnewood, PA 19096 (Email: samuelsl{at}mlhs.org).

Background: We describe our experience with argatroban as a primary or secondary postoperative anticoagulant to heparin in patients receiving ventricular assist devices.

Methods: This is a retrospective review of all Abiomed (BVS5000, AB5000) and Thoratec (PVAD and IVAD) ventricular assist devices from May 2003 through May 2006 at a single institution. Postoperatively, patients received either heparin or argatroban as their anticoagulant. Patients in whom heparin-induced thrombocytopenia was suspected or confirmed were converted from heparin to argatroban.

Results: There were 33 Abiomed and Thoratec ventricular assist devices implanted. Thirteen patients received heparin as their primary postoperative anticoagulant; 8 of the 13 were converted to argatroban as a secondary anticoagulant (hep-arg), and 5 patients remained with heparin as their only anticoagulant. Twenty patients received argatroban as their primary and only postoperative anticoagulant. Thrombocytopenia occurred in 26 patients (79%) overall, 16 (80%) with argatroban only, 6 (75%) with hep-arg, and 4 (80%) with heparin only. Thromboembolic events occurred in 5 patients (15%) overall, 3 (15%) with argatroban only, 1 (13%) with hep-arg, and 1 (20%) with heparin only. Postoperative bleeding requiring reexploration occurred in 5 patients overall (15%), 1 with argatroban only (5%), 3 (38%) with hep-arg, and 1 (20%) with heparin only. Enzyme-linked immunosorbent assay heparin-induced thrombocytopenia tests were positive in 7 patients overall (21%), 5 (25%) with argatroban only, 2 (25%) with hep-arg, and 0 (0%) with heparin only.

Conclusions: Argatroban is a comparable primary or secondary anticoagulant to heparin postoperatively in patients receiving ventricular assist devices.

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Invited Commentary

John Butterworth
Ann. Thorac. Surg. 2008 85: 1655. [Extract] [Full Text] [PDF]

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