Argatroban for anticoagulation of a blood salvage system - an ex-vivo study

Abstract

BackgroundBlood salvage systems help to minimize intraoperative transfusion of allogenic blood. So far no data is available on the use of argatroban for anticoagulation of such systems.We conducted an ex-vivo trial to evaluate the effectiveness of three different argatroban doses as compared to heparin and to assess potential residual anticoagulant in the red cell concentrates.MethodsWith ethical approval and individual informed consent, blood of 23 patients with contraindications for use of blood salvage systems during surgery was processed by the Continuous-Auto-Transfusion-System (C.A.T.S. ® Cell Saver System, Fresenius Kabi, Bad Homburg, Germany) using 5,50 or 250 mg of argatroban or 25.000 U of heparin in 1000 ml saline for anticoagulation of the system. Emergency and high-quality washing modes were applied in random order. Patency of the system and residual amount of anticoagulants in the re-transfusion bag were measured. The collected blood was not re-infused, but only used for analysis of hematocrit, heparin and argatroban concentrations.ResultsPatency of the system was provided by all anticoagulants except for 3/8 cases with 5 mg of argatroban. Residual anticoagulant was found in 2/10 (20 %) heparin samples in two different patients (1 emergency and 1 high-quality washing) and in all argatroban samples. High quality washing eliminated 89–95 % and emergency washing 60–90 % of the initial argatroban concentration. Residual argatroban concentrations ranged from 55 ng ml−1 to 6810 ng ml−1, with initial argatroban concentrations of 5 and 250 mg, respectively.ConclusionThe C.A.T.S. does not reliably remove heparin and should therefore not be used in HIT patients. Anticoagulation with 50 and 250 mg argatroban, maintains the systems patency and is significantly removed during washing. In this ex-vivo study a concentration of 50 μg ml−1 argatroban provided the best ratio of system patency and residual argatroban concentration. Additional dose-finding studies with different blood salvage systems are needed to evaluate the optimal argatroban concentration.

Performance of a new‐generation continuous autotransfusion device including fat removal and consequences for quality controls

“…Sufficient anticoagulation of the wound blood is essential to prevent clogging and respective RBC loss (Beiderlinden et al ., ). In our study, heparin was removed efficiently, meeting the recommended quality standards.…”

“…In addition, the relative insensitivity of the heparin detection system contributes to the particularly high values of elimination rates (Thomas et al ., ). Despite these rates exceeding 99%, the contraindication for using heparin during cell salvage in patients with HIT remains (Beiderlinden et al ., ). In contrast to the other quality parameters, with heparin, the measurement of concentrations is more expedient in the clinical setting than considering removal rates.…”

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

“…cytes, and heparin. The technique involves heparinisation of the serum that irrigates the surgical field, using sodium heparin 25,000-30,000 IU in 1000 mL saline 0.9% or citrate dextrose 60-80 drops/min, or even argatroban [14]. Blood damage is reduced when blood is diluted in saline while being suctioned from the surgical field.…”