title: Argatroban as an alternative to heparin in extracorporeal membrane oxygenation circuits.
abstract: 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.
authors.affiliation: Division of Hematology, Children's Hospital of Orange County, Orange, CA 92868, USA. gyoung@choc.org
authors.forename: Guy
authors.initials: G
authors.lastname: Young
authors.forename: Karyn E
authors.initials: KE
authors.lastname: Yonekawa
authors.forename: Peggy
authors.initials: P
authors.lastname: Nakagawa
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Nugent
mesh_terms: D001120:Arginine / Q000031:analogs & derivatives; D015415:Biomarkers / Q000032:analysis; D001780:Blood Coagulation Tests; D004868:Equipment Failure; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D010875:Pipecolic Acids / Q000627:therapeutic use*; D013449:Sulfonamides; D013916:Thrombelastography; D013917:Thrombin / Q000096:biosynthesis; D013927:Thrombosis
chemical_list: D015415:Biomarkers; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban