Thrombosis Research
Volume 126, Issue 3 , Pages e196-e200, September 2010

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

  • Lars Maegdefessel

      Affiliations

    • Department of Medicine III at the University Hospital Haale (Saale), Martin-Luther-University Halle-Wittenberg, Germany
    • Corresponding Author InformationCorresponding author. Stanford University – School of Medicine, Division of Cardiovascular Medicine, 300 Pasteur Drive, Falk CVRB, Stanford, CA 94305 – 5406 USA. Tel.: +1 650 724 5075; fax: +1 650 725 1599.
    • Present address: Division of Cardiovascular Medicine, Stanford University – School of Medicine, Stanford, CA, USA.
    • ,
  • Torsten Linde

      Affiliations

    • Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
    • ,
  • Franziska Krapiec

      Affiliations

    • Department of Medicine III at the University Hospital Haale (Saale), Martin-Luther-University Halle-Wittenberg, Germany
    • ,
  • Kathrin Hamilton

      Affiliations

    • Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
    • ,
  • Ulrich Steinseifer

      Affiliations

    • Applied Medical Engineering at the Helmholtz Institute, RWTH Aachen University, Aachen, Germany
    • ,
  • Joanne van Ryn

      Affiliations

    • Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
    • ,
  • Uwe Raaz

      Affiliations

    • Department of Medicine III at the University Hospital Haale (Saale), Martin-Luther-University Halle-Wittenberg, Germany
    • ,
  • Michael Buerke

      Affiliations

    • Department of Medicine III at the University Hospital Haale (Saale), Martin-Luther-University Halle-Wittenberg, Germany
    • ,
  • Karl Werdan

      Affiliations

    • Department of Medicine III at the University Hospital Haale (Saale), Martin-Luther-University Halle-Wittenberg, Germany
    • ,
  • Axel Schlitt

      Affiliations

    • Department of Medicine III at the University Hospital Haale (Saale), Martin-Luther-University Halle-Wittenberg, Germany

Received 8 March 2010; received in revised form 15 June 2010; accepted 16 June 2010. published online 26 July 2010.

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 (230ml) from healthy young male volunteers was anticoagulated either by dabigatran (1μmol/l), UFH (150IU), or LMWH (100IU). 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 15-20minutes. When blood was treated with dabigatran, the mean thrombus weight was 164±55mg, in the UFH group 159±69mg, and in the LMWH group 182±82mg (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.

Keywords: Anticoagulation, Mechanical heart valve, Thrombosis, Dabigatran, Heparins

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☆ The results of the study have been presented at the ISTH (International Society of Thrombosis and Haemostasis) Meeting 2009 in Boston (16.07.2009), the ESC (European Society of Cardiology) Meeting 2009 in Barcelona (31.08.2009), and the DGK (Deutsche Gesellschaft für Kardiologie) Meeting 2009 in Mannheim (18.04.2009).

PII: S0049-3848(10)00350-6

doi:10.1016/j.thromres.2010.06.011

Thrombosis Research
Volume 126, Issue 3 , Pages e196-e200, September 2010

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