Argatroban

[khedlund]

We are currently using Argatroban as an anticoagulant during ventricular assist with the Abiomed Blood Pump(s). Does anyone have experience with this drug? We generally run the drug rate at 3 mcg/kg/min such that the pTT is 60-70 seconds. Is this satisfactory to prevent fibrin formation in the circuit?

Kelly D. Hedlund, MS, CCP
The Michael E. DeBakey Heart Institute of Kansas
Hays, Kansas, USA

[Jim Reagor]

Kelly,

I have no experience with Argatoroban in the Abiomed pumps. However, this article does report its usage in a few Abiomed patients.

The general anticoaguation protocol for the Abiomed BVS pump when measured via pTT is 2 to 2.5 times normal. In addition, if flows can be maintained at 4L/min or greater this will aid in the washout of the device an help prevent any clot formation. If your flows are less than 3 L/min. pTT's should be maintained at 2.5 - 3 times control. (Abiomed Clinical Reference Manual Pages 38-39)

I hope your patient is still doing well. Good luck.

[Celine]

I dont recall using argatroban in AB 5000 specifically, however I have used it in other VAD's including PVAD. I usually titrate it to a ratio that is appropriate for the individual device, following PTT Ratio's of 2.0 -2.5 x's normal. If INR reaches >6.0 it needs to be considered as a "truely elevated INR" and not just "falsely elevated secondary to argatroban" and argatroban should be stopped. There are several institutions I am aware of that only use heparin intraop and then switch to argatroban post op on a variety of VAD's secondary to the rising incidence of HIT in our patients. None of those surgeons have reported increased thrombotic complications and bleeding complications seem equal to those with heparin.