Argatroban Inhibits Intraocular Fibrin Formation After Vitrectomy in Rabbits

Abstract

Objectives: To examine whether the specific thrombin inhibitor argatroban can prevent anterior chamber, pupillary area, and anterior vitreous fibrin formation after vitrectomy and lensectomy in rabbits. Methods: Argatroban was infused into the vitreous cavities of Japanese albino rabbits for 5 minutes after pars plana vitrectomy and lensectomy. Slitlamp microscopy and indirect ophthalmoscopy were performed at postoperative hours 0.5, 1, 2, 3, and 6, and at postoperative days 1, 2, 3, and 7, and the amounts of fibrin formation in the anterior chamber, pupillary area, and anterior vitreous were scored from grade 0 to 4. Results: Argatroban prevented fibrin formation from 0.5 hours postoperatively in a dose-dependent manner. In the eyes treated with 0.01% argatroban, the median score for postoperative fibrin formation was significantly less than that in control eyes between hours 1 and 3 (hour 1, P =.02; hour 2, P=.005; and hour 3, P =.003); the eyes treated with 0.003% argatroban also had significantly less fibrin than control eyes between 1 and 2 hours (hour 1, P=.005; hour 2, P =.03). Conclusion: These results indicate that argatroban inhibits intraocular fibrin formation in an experimental rabbit model. Clinical Relevance: Argatroban may be useful clinically in cases that often produce fibrin postoperatively, such as proliferative vitreoretinopathy and proliferative diabetic retinopathy.

Effects of Thrombin on RPE Cells Are Mediated by Transactivation of Growth Factor Receptors

“…It is known that PARs transmit proinflammatory signals including the expression of inflammatory and growth factors, 44 and that anticoagulant therapy attenuates inflammatory responses and fibrin formation in the retina. [45][46][47] It is suggested that the therapeutic action of triamcinolone in retinal edema and neovascularization is mediated in part by the inhibitory effect on the action of thrombin. Thrombin is used as a therapeutic agent, for example, for the closure of macular holes 48 ; this effect of thrombin may be mediated by the autocrine/paracrine mitogenic 21,22 and motogenic action of PDGF (Fig.…”

Retroprosthetic Membranes in AlphaCor Patients

“…31 Maeno et al proposed the more specific inhibitor Argatroban. 32 If prevention fails to be effective and an RPM forms, AlphaCor data suggest that if detected early the membrane may respond well to Nd:Yag and topical steroid therapy. Possible damage to PMMA KPro optics by Nd:Yag was suggested following in vitro studies 33 but appears not to be a problem clinically with PMMA-optic devices.…”

Vitrectomy for Proliferative Diabetic Retinopathy in a Patient with Heparin-Induced Thrombocytopenia

“…The drugs half-life is 30 min, and it has an anticoagulant effect for about 15 min after administration. Therefore, by stopping argatroban as soon as the dissection of the fibrovascular membranes is completed, there is little risk of postoperative bleeding and clotting can be safely controlled [ 13 ]. A worsening of PDR with increased platelet aggregation has also been reported [ 14 , 15 ].…”