title: Argatroban, an attractive anticoagulant, for left heart bypass with centrifugal pump for repair of traumatic aortic rupture.
abstract: Systemic heparinization often increases the risk of fatal bleeding from other injured organs in surgical repair of the aorta using extracorporeal circulation in patients with traumatic aortic rupture associated with multisystem injuries. We used an antithrombin agent, argatroban, as an alternative anticoagulant in left heart bypass with the Bio-Medicus centrifugal pump in 7 of 9 recent patients who underwent aortic repair using left heart bypass. All these patients survived without obvious evidence of systemic thromboembolization. Surgical treatments for other organ injuries were carried out in 3 patients concomitantly or immediately after aortic repairs without undue blood loss. Argatroban may have a complementary effect for preventing thrombus formation without aggravating bleeding tendency because of its monotarget specificity to thrombin. We believe intravenous administration (0.5 to 2 micrograms/kg/min) of argatroban is a safe anticoagulant for left heart bypass in repairs of traumatic aortic rupture associated with multiple organ injuries.
authors.affiliation: First Department of Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kawada
authors.forename: Y
authors.initials: Y
authors.lastname: Okada
authors.forename: M
authors.initials: M
authors.lastname: Hoson
authors.forename: S
authors.initials: S
authors.lastname: Endo
authors.forename: M
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Y
authors.initials: Y
authors.lastname: Kitanaka
authors.forename: K
authors.initials: K
authors.lastname: Kimura
authors.forename: H
authors.initials: H
authors.lastname: Abe
authors.forename: N
authors.initials: N
authors.lastname: Yamate
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D000991:Antithrombins / Q000627:therapeutic use*; D001019:Aortic Rupture / Q000601:surgery*; D001120:Arginine / Q000031:analogs & derivatives; D004341:Drug Evaluation; D005260:Female; D018611:Heart Bypass, Left / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D010875:Pipecolic Acids / Q000627:therapeutic use*; D013449:Sulfonamides
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D010875:Pipecolic Acids; D013449:Sulfonamides; D001120:Arginine; C031942:argatroban