Failure of argatroban anticoagulation during off-pump coronary artery bypass surgery

• Published in: The Annals of thoracic surgery Vol. 77; no. 2; pp. 711 - 713
• Main Authors: Cannon, Mark A, Butterworth, John, Riley, Robert D, Hyland, Jacqueline M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2004; Elsevier Science
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angina, Unstable - surgery; Antibodies - blood; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cardiopulmonary Bypass; Coronary Artery Bypass; Coronary Restenosis - surgery; Dose-Response Relationship, Drug; Graft Occlusion, Vascular - etiology; Heparin - adverse effects; Heparin - immunology; Heparin - therapeutic use; Humans; Male; Medical sciences; Myocardial Revascularization; Partial Thromboplastin Time; Pipecolic Acids - adverse effects; Pipecolic Acids - therapeutic use; Pneumology; Reoperation; Stents; Treatment Failure; 25; Treatment; Aortocoronary; Bypass; Surgery; Coronary artery; Surgical anastomosis; Argatroban; Anesthesia; Circulatory system; Cardiology; Failure
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2003.04.001

Heparin-induced antibodies create vexing problems during cardiac surgery. Although alternative medications have been used for intraoperative anticoagulation, the results have been sufficiently variable that no one medication is recommended. In our case, due to the poor reversibility of the antithrombin agents, argatroban was chosen as a heparin substitute due to its short half-life and its anticoagulation assessment using the activated clotting time (ACT). Unfortunately, our experience was that argatroban does not provide adequate anticoagulation during off-pump coronary bypass surgery, even when the ACT is maintained at more than 380 sec.