Argatroban as an alternative to heparin in extracorporeal membrane oxygenation circuits

Young, Guy; Yonekawa, Karyn E.; Nakagawa, Peggy; Nugent, Diane J.
September 2004
Perfusion;Sep2004, Vol. 19 Issue 5, p283
Academic Journal
We investigated the anticoagulant effects of argatroban, a direct thrombin inhibitor, versus heparin in extracorporeal membrane oxygenation (ECMO) circuits. Three sham circuits were prepared according to our hospital's standard practice and run for six hours simultaneously. Two circuits were anticoagulated with argatroban (one with heparin in the wet prime and one without). One circuit had heparin in the initial prime and was then anticoagulated with heparin. We measured thrombin generation (prothrombin fragment 1 + 2, D-dimer and thrombin - antithrombin complexes), activated clotting times (ACTs) and partial thromboplastin times (aPTTs), and monitored thrombus formation using thromboelastography. ACTs were >1000 s in each circuit throughout assessment. No clot initiation was detected by thromboelastography. Thrombin generation was decreased in circuits anticoagulated with argatroban versus heparin, despite aPTTs being less prolonged. These results suggest that argatroban may be more efficacious than heparin for anticoagulation in ECMO. Additional studies are warranted to further evaluate argatroban in this setting.


Related Articles

  • Potential drug sequestration during extracorporeal membrane oxygenation: results from an ex vivo experiment. Mehta, Nilesh M.; Halwick, David R.; Dodson, Brenda L.; Thompson, John E.; Arnold, John H. // Intensive Care Medicine;Jun2007, Vol. 33 Issue 6, p1018 

    Objective: Using an ex vivo simulation model we set out to estimate the amount of drug lost due to sequestration within the extracorporeal circuit over time.Design: Simulated closed-loop extracorporeal membrane oxygenation (ECMO) circuits were prepared using a 1.5-m2...

  • Bioline heparin-coated ECMO with bivalirudin anticoagulation in a patient with acute heparin-induced thrombocytopenia: the immune reaction appeared to continue unabated. Pappalardo, F.; Maj, G.; Scandroglio, A.; Sampietro, F.; Zangrillo, A.; Koster, A. // Perfusion;Mar2009, Vol. 24 Issue 2, p135 

    Heparin-induced thrombocytopenia (HIT) is a serious, antibody-mediated complication of heparin which significantly confers risks of thrombosis and devastating outcomes. Once diagnosed, it requires immediate cessation of heparin and therapy with an alternative anticoagulant. No data are available...

  • The use of continuous renal replacement therapy in series with extracorporeal membrane oxygenation. Santiago, Maria J.; Sánchez, Amelia; López-Herce, Jesús; Pérez, Rosario; del Castillo, Jimena; Urbano, Javier; Carrillo, Angel // Kidney International;Dec2009, Vol. 76 Issue 12, p1289 

    A large percentage of patients on extracorporeal membrane oxygenation (ECMO) require continuous renal replacement therapy (CRRT) usually performed through a different venous access or by introducing a filter into the ECMO circuit. Here, we evaluated the efficacy and safety of including a CRRT...

  • ECMO and endogenous carboxyhemoglobin formation. Tripathi, Ravi S.; Papadimos, Thomas J. // International Journal of Critical Illness & Injury Science;Jul-Dec2011, Vol. 1 Issue 2, p168 

    The article describes a case of extremely high and poisonous carboxyhemoglobin (COhb) level in a 41-year-old patient on extracorporeal membrane oxygenation (ECMO). The patient presented with shortness of breath and hypoxemia, requiring mechanical ventilation. The patient was given inhaled nitric...

  • Rat model of veno-arterial extracorporeal membrane oxygenation. Ali, Ayyaz A.; Downey, Peter; Singh, Gopal; Wei Qi; George, Isaac; Takayama, Hiroo; Kirtane, Ajay; Krishnan, Prakash; Zalewski, Adrian; Freed, Darren; Large, Stephen R.; Ashley, Euan A.; Leon, Martin B.; Bacchetta, Matthew; Ali, Ziad A. // Journal of Translational Medicine;2014, Vol. 12 Issue 1, p1 

    Background We aim to develop a rat model of veno-arterial extracorporeal membrane oxygenation (VAECMO). Methods VA-ECMO was established in twelve Male Sprague-Dawley rats (250-350 g) through cannulation of the right jugular vein for venous drainage and the right femoral artery for arterial...

  • Nosocomial infections during extracorporeal membrane oxygenation. O'Neill, J.; Schutze, G.; Heulitt, M.; Simpson, P.; Taylor, B.; O'Neill, J M; Schutze, G E; Heulitt, M J; Simpson, P M; Taylor, B J // Intensive Care Medicine;Aug2001, Vol. 27 Issue 8, p1247 

    Objective: To examine trends in nosocomial infection associated with Extracorporeal Membrane Oxygenation (ECMO).Design: Retrospective review of all patients who underwent ECMO over a 4-year period at our institution; specifically, examining reasons for placement and...

  • Cardiac ECMO for biventricular hearts after paediatric open heart surgery. Chaturvedi, R. R.; Macrae, D.; Brown, K. L.; Schindler, M.; Smith, E. C.; Davis, K. B.; Cohen, G.; Tsang, V.; Elliott, M.; de Leval, M.; Gallivan, S.; Goldman, A. P. // Heart;May2004, Vol. 90 Issue 5, p545 

    Objective: To delineate predictors of hospital survival in a large series of children with biventricular physiology supported with extracorporeal membrane oxygenation (ECMO) after open heart surgery.Results: 81 children were placed on ECMO after open heart surgery. 58%...

  • A comparison of radiographic signs of pulmonary inflammation during ECMO between silicon and poly-methyl pentene oxygenators. Khoshbin, Espeed; Dux, Anthony E. W.; Killer, Hilliary; Sosnowski, Andrzej W.; Firmin, Richard K.; Peek, Giles J. // Perfusion;Jan2007, Vol. 22 Issue 1, p15 

    Introduction: The inflammatory response caused by extracorporeal membrane oxygenation (ECMO) is clearly visible within the first 24 h of cannulation. The inflammatory process affects all areas of the lung, even areas previously spared by the primary disease. Objective: To compare the change in...

  • Is it possible to predict outcome in pulmonary ECMO? Analysis of pre-operative risk factors. Wagner, K.; Risnes, I.; Abdelnoor, M.; Karlsen, H. M.; Svennevig, J. L. // Perfusion;Mar2008, Vol. 23 Issue 2, p95 

    Serious pulmonary failure may be treated with extracorporeal membrane oxygenation (ECMO) when other treatment has failed. The aim of this study was to analyze preoperative risk factors of early mortality in patients who underwent either veno-arterial (VA) ECMO or venovenous (VV) ECMO for...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics