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Original Articles: Adult Cardiac

Invited Commentary

Department of Anesthesia, Indiana University School of Medicine, 204 South Dr, FH 204, Indianapolis, IN 46202

(Email: jfbutter{at}iupui.edu).

Unfractionated heparin, first purified, named, and used in experimental surgery in the first quarter of the 20th century, remains an extraordinarily versatile drug when temporary and profound degrees of anticoagulation are needed [1]. Unfortunately, prolonged or repeated exposure to unfractionated heparin, increasingly common in the current era, can lead to heparin-induced thrombocytopenia (HIT). The HIT will generally preclude subsequent use of unfractionated heparin. To avoid prolonged exposure to unfractionated heparin, except in those patients for whom there is no reasonable alternative, seems to be sensible in practice. Nevertheless, there is no consensus as to how to best manage anticoagulation in settings where persisting anticoagulation is needed, as in patients implanted with ventricular assist devices (VADs).

Samuels and colleagues [2] describe their clinical experiences using argatroban rather than heparin for maintenance anticoagulation after VAD implantation. These pilot data are very encouraging and provide strong justification for a prospective, multicenter clinical trial in patients without HIT implanted with VADs. Such a trial should have adequate numbers of subjects to determine whether outcomes are better with argatroban as the primary anticoagulant strategy; however, gathering such data would not be easy. Ideally, the trial would be conducted under the terms of an "Investigational New Drug" (IND) application from the United States Food and Drug Administration, so that positive results may lead to a new labeled indication for argatroban.

	References

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1. McAlister V. Control of coagulation: a gift of Canadian agriculture Clin Invest Med 2006;29:373-377.[Medline]
2. Samuels LE, Kohout J, Casanova-Ghosh E, et al. Argatroban as a primary or secondary postoperative anticoagulant in patients implanted with ventricular assist devices Ann Thorac Surg 2008;85:1651-1655.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Butterworth, J. Search for Related Content PubMed PubMed Citation Articles by Butterworth, J. Related Collections Cardiac - pharmacology Related Article