Anticoagulant therapy during cardiopulmonary bypass

Abstract

The prothrombotic and hemostatic-altering environment that characterizes cardiac surgery in general and cardiopulmonary bypass (CPB) in particular is unparalleled in medicine, causing, in an alarming number of patients, both thrombotic and hemorrhagic events. Fundamentally, the primary objective of anticoagulant therapy during CPB is to prevent thrombin generation and its attendant prothrombotic, proinflammatory, and vascular effects. Though anticoagulation with unfractionated heparin has been the standard of care for more than a half-century for patients undergoing cardiac surgery, inherent limitations, and an unfavorable safety profile will increasingly stimulate the investigation and development of more safe and effective therapies.

Probing the Coagulation Pathway with Aptamers Identifies Combinations that Synergistically Inhibit Blood Clot Formation

“…During CPB, the patient's blood is removed from the heart and siphoned off into a machine (extracorporeal circuit) that replaces heart and lung function. Potent systemic anticoagulation is required during CPB to maintain blood fluidity in response to numerous stimuli (Levi, et al, 2011; Yavari and Becker, 2008). Unfractionated heparin (UFH), which is a glycosaminoglycan that targets multiple coagulation factors, and its antidote protamine are the current standard of care for CPB anticoagulation.…”

Małopłytkowość indukowana protaminą — nowy problem czy inny typ małopłytkowości poheparynowej?

“…Obok doskonalenia technik operacyjnych i anestezjologicznych jest wymagana przede wszystkim skuteczna i bezpieczna terapia przeciwzakrzepowa. Lekiem pierwszego wyboru stosowanym w trakcie zabiegu CPB jest heparyna niefrakcjonowana, natomiast środkiem odwracającym jej działanie jest wyłącznie siarczan protaminy [2]. Dzięki szybkiej neutralizacji efektu przeciwkrzepliwego heparyny, protamina stanowi podstawę tego zabiegu, niezbędną do osiągnięcia chirurgicznej hemostazy.…”

First in man study of EP217609, a new long-acting, neutralisable parenteral antithrombotic with a dual mechanism of action

“…Heparin with its antidote protamine is the current standard of care, but its use is empiric, i.e. not based on adequate randomised clinical trials, and associated with limitations and side effects [7][8][9]. EP217609 and its antidote avidin have entered clinical development and may ultimately provide an alternative to heparin and protamine.…”