Rotational Thromboelastometry for Coagulation Management During Cardiopulmonary Bypass Using Argatroban

Hirasaki, Yuji; Yamamoto, Yosuke; Nakamura, Takahide; Higa, Yuki; Honda, Masahiro; Yoshida, Shigeaki

doi:10.1053/j.jvca.2018.09.028

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…73 Case reports of argatroban use in CPB have noted difficulty in achieving adequate anticoagulation. 72,74,75 In one case report, CPB was established after a bolus of argatroban followed by continuous infusion to achieve an activated clotting time (ACT) > 480s. 74 However, the ACT response was found to be unpredictable, and the target ACT was difficult to maintain despite repeated boluses.…”

Section: Argatrobanmentioning

confidence: 99%

“…72,74,75 In one case report, CPB was established after a bolus of argatroban followed by continuous infusion to achieve an activated clotting time (ACT) > 480s. 74 However, the ACT response was found to be unpredictable, and the target ACT was difficult to maintain despite repeated boluses. In this case, anticoagulation was confirmed with rotational thromboelastometry.…”

Section: Argatrobanmentioning

confidence: 99%

“…In this case, anticoagulation was confirmed with rotational thromboelastometry. 74 Another report described the death of a 12 year-old patient undergoing heart transplantation due to a clot in the CPB circuit despite an ACT of > 800s. 75 A recent systematic review included four cohort studies and 9 case series totaling 307 patients with the use of argatroban during ECMO.…”

Section: Argatrobanmentioning

confidence: 99%

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Alternatives to heparin anticoagulation for cardiopulmonary bypass and extracorporeal membrane oxygenation

Malviya

Bruner

Belfar

et al. 2021

MRAJ

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Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are both mechanical circulatory support technologies that augment the native heart and/or lung function. They involve drainage and reinfusion of blood while performing extracorporeal gas exchange. 1 In both devices, contact between patient blood and the non-endothelialized surface of the circuit triggers an inflammatory response and pro-coagulation cascade. 2–5 As a result, prophylactic anticoagulation is integral to prevent catastrophic thrombosis of the circuitry. In rare instances, there exist contraindications to heparin use, necessitating alternative management strategies. 6 In this review, we will examine heparin contraindications in mechanical circulatory support and summarize alternative approaches to anticoagulation in these circumstances.

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