title: Argatroban as a primary or secondary postoperative anticoagulant in patients implanted with ventricular assist devices.
abstract: BACKGROUND
  We describe our experience with argatroban as a primary or secondary postoperative anticoagulant to heparin in patients receiving ventricular assist devices.
  
  
  METHODS
  This is a retrospective review of all Abiomed (BVS5000, AB5000) and Thoratec (PVAD and IVAD) ventricular assist devices from May 2003 through May 2006 at a single institution. Postoperatively, patients received either heparin or argatroban as their anticoagulant. Patients in whom heparin-induced thrombocytopenia was suspected or confirmed were converted from heparin to argatroban.
  
  
  RESULTS
  There were 33 Abiomed and Thoratec ventricular assist devices implanted. Thirteen patients received heparin as their primary postoperative anticoagulant; 8 of the 13 were converted to argatroban as a secondary anticoagulant (hep-arg), and 5 patients remained with heparin as their only anticoagulant. Twenty patients received argatroban as their primary and only postoperative anticoagulant. Thrombocytopenia occurred in 26 patients (79%) overall, 16 (80%) with argatroban only, 6 (75%) with hep-arg, and 4 (80%) with heparin only. Thromboembolic events occurred in 5 patients (15%) overall, 3 (15%) with argatroban only, 1 (13%) with hep-arg, and 1 (20%) with heparin only. Postoperative bleeding requiring reexploration occurred in 5 patients overall (15%), 1 with argatroban only (5%), 3 (38%) with hep-arg, and 1 (20%) with heparin only. Enzyme-linked immunosorbent assay heparin-induced thrombocytopenia tests were positive in 7 patients overall (21%), 5 (25%) with argatroban only, 2 (25%) with hep-arg, and 0 (0%) with heparin only.
  
  
  CONCLUSIONS
  Argatroban is a comparable primary or secondary anticoagulant to heparin postoperatively in patients receiving ventricular assist devices.
authors.affiliation: Department of Cardiothoracic Surgery, Lankenau Hospital, Wynnewood, Pennsylvania 19096, USA. samuelsl@mlhs.org
authors.forename: Louis E
authors.initials: LE
authors.lastname: Samuels
authors.forename: Jaromir
authors.initials: J
authors.lastname: Kohout
authors.forename: Elena
authors.initials: E
authors.lastname: Casanova-Ghosh
authors.forename: Kevin
authors.initials: K
authors.lastname: Hagan
authors.forename: Phil
authors.initials: P
authors.lastname: Garwood
authors.forename: Francis
authors.initials: F
authors.lastname: Ferdinand
authors.forename: Scott M
authors.initials: SM
authors.lastname: Goldman
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001120:Arginine / Q000031:analogs & derivatives; D001323:Autoantibodies / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D051741:Kruppel-Like Transcription Factors / Q000276:immunology; D010314:Partial Thromboplastin Time; D010875:Pipecolic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D011182:Postoperative Care; D011183:Postoperative Complications / Q000139:chemically induced* / Q000188:drug therapy / Q000401:mortality; D011474:Prosthesis Design; D012097:Repressor Proteins / Q000276:immunology; D012189:Retrospective Studies; D013449:Sulfonamides; D015996:Survival Rate; D013917:Thrombin / Q000037:antagonists & inhibitors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D001323:Autoantibodies; D051741:Kruppel-Like Transcription Factors; D010875:Pipecolic Acids; D012097:Repressor Proteins; D013449:Sulfonamides; C115768:ZNF85 protein, human; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban