In vitro comparison of dabigatran, unfractionated heparin, and low-molecular-weight heparin in preventing thrombus formation on mechanical heart valves

In vitro comparison of dabigatran, unfractionated heparin, and low-molecular-weight heparin in preventing thrombus formation on mechanical heart valves

Abstract Introduction Lifelong oral anticoagulation (OAC) therapy is required for the prevention of thromboembolic events after implantation of an artificial heart valve. Thromboembolism and anticoagulant-related bleedings account for ≈ 75% of all complications experienced by heart valve recipients...

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Bibliographic Details
Published in:Thrombosis research Vol. 126; no. 3; pp. e196 - e200
Main Authors: Maegdefessel, Lars, Linde, Torsten, Krapiec, Franziska, Hamilton, Kathrin, Steinseifer, Ulrich, van Ryn, Joanne, Raaz, Uwe, Buerke, Michael, Werdan, Karl, Schlitt, Axel
Format: Journal Article
Language:English
Published: United States Elsevier Ltd 01-09-2010
Subjects:
Administration, Oral
Anticoagulants - administration & dosage
Anticoagulants - pharmacology
Anticoagulation
Benzimidazoles - administration & dosage
Benzimidazoles - pharmacology
Blood Coagulation - drug effects
Dabigatran
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - pharmacology
Heart Valve Prosthesis - adverse effects
Hematology, Oncology and Palliative Medicine
Heparin - administration & dosage
Heparin - pharmacology
Heparin, Low-Molecular-Weight - administration & dosage
Heparin, Low-Molecular-Weight - pharmacology
Heparins
Humans
Male
Mechanical heart valve
Prosthesis Design
Pyridines - administration & dosage
Pyridines - pharmacology
Thrombosis
Thrombosis - blood
Thrombosis - etiology
Thrombosis - prevention & control
Time Factors
Mechanical heart valve
Anticoagulation
Dabigatran
Thrombosis
Heparins
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Summary:Abstract Introduction Lifelong oral anticoagulation (OAC) therapy is required for the prevention of thromboembolic events after implantation of an artificial heart valve. Thromboembolism and anticoagulant-related bleedings account for ≈ 75% of all complications experienced by heart valve recipients (2-9% of patients per year). The present study investigated the efficacy of dabigatran, a new direct thrombin inhibitor for oral use, as compared to unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) in preventing thrombus formation on mechanical heart valves in vitro. Material and Methods Blood (230 ml) from healthy young male volunteers was anticoagulated either by dabigatran (1 μmol/l), UFH (150 IU), or LMWH (100 IU). Mechanical heart valve prostheses were placed in an in vitro thrombosis tester and exposed to the anticoagulated blood samples under continuous circulation at a rate of 75 beats per minute. Results In whole blood with no anticoagulant, the apparatus completely clotted in 15-20 minutes. When blood was treated with dabigatran, the mean thrombus weight was 164 ± 55 mg, in the UFH group 159 ± 69 mg, and in the LMWH group 182 ± 82 mg (p-value: 0.704). Electron microscopy showed no significant difference in thrombus formation in any group. Conclusisons Dabigatran was as effective as UFH and LMWH in preventing thrombus formation on mechanical heart valves in our in vitro investigation. Thus, we hypothesize that dabigatran etexilate might potentially be a useful and competitive orally administered alternative to UFH and LMWH for recipients of alloplastic heart valve prostheses.
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ISSN:0049-3848
1879-2472
DOI:10.1016/j.thromres.2010.06.011