Clinical Application of Argatroban as an Anticoagulant for PCPS: Its Advantages is Reducing the Risk of Bleeding as Determined by Hemostatic Molecular Markers

• Published in: Jinko Zoki Vol. 28; no. 2; pp. 412 - 415
• Main Authors: Okada, Y, Kawada, T, Hoson, M, Miyamoto, S, Takei, H, Funaki, S, Okada, T, Ikeshita, M, Yamate, N, Hiekata, T
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY FOR ARTIFICIAL ORGANS 1999
• Subjects: anticoagulant; argatroban; hemostatic molecular markers; percutaneous cardiopulmonary support (PCPS)
• ISSN: 0300-0818; 1883-6097
• DOI: 10.11392/jsao1972.28.412

Argatroban, a direct thrombin inhibitor, transiently and selectively combines with thrombin and blocks its effects by converting fibrinogen to fibrin. Platelet activation induced by thrombin is consequently suppressed as well by argatroban treatment. In our institution, argatroban has been preliminarily used as an alterna tive anticoagulant in extracorporeal circulation in which a blood reservoir is not required within the circuit. In this study, to evaluate argatroban's hematological effects, hemostatic and thrombocytic molecular markers were determined in five cases who underwent percutaneous cardiopulmonary support (PCPS) for more than 48 hrs using argatroban as an anticoagulant. Platelet counts and fibrinogen plasma levels were preserved during PCPS. Release reaction of platelet-specific proteins, θ-thrombog lobulin (θ-TG), and platelet factor 4 (PF 4) was suppressed to some extent during PCPS, but plasma levels of these proteins tended to be increased again after discontinuation of PCPS. Antithrombin III (ATIII) and thrombin-antithrombin III complex (TAT) also showed some increase in the plasma after PCPS, though peculiar changes in fibrinopeptide A (FPA) and prothrombin fragment 1.2 (F1+2) were not recognized. Platelet activation and excessive platelet consumption tented to be suppressed to some extent, while plasma levels of fibrinogen were increased by argatroban treatment during PCPS. Although further study is necessary, this clinical study suggests that the risk of bleeding can be effectively reduced without systemic thromboembolization by the use of argatroban during PCPS.