Stephen H. McKellar, MD, MSc, Stuart Abel, BS, Christopher L

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Presentation transcript:

Effectiveness of dabigatran etexilate for thromboprophylaxis of mechanical heart valves Stephen H. McKellar, MD, MSc, Stuart Abel, BS, Christopher L. Camp, MD, Rakesh M. Suri, MD, DPhil, Mark H. Ereth, MD, Hartzell V. Schaff, MD The Journal of Thoracic and Cardiovascular Surgery Volume 141, Issue 6, Pages 1410-1416 (June 2011) DOI: 10.1016/j.jtcvs.2011.02.011 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Heterotopic aortic valve model demonstrating the modified valved conduit (St Jude Masters Series; St Jude Medical, Inc, Minneapolis, Minn) as it bypasses the ligated native descending thoracic aorta (used with permission from Mayo Foundation for Medical Education and Research). The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1410-1416DOI: (10.1016/j.jtcvs.2011.02.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Results of dosing study for enoxaparin and dabigatran etexilate for 3 animals. A, For dabigatran etexilate, the goal was an activated partial thromboplastin time (APTT) of 60 seconds (2–2.5 times normal). B, The goal for enoxaparin was an anti-Xa level of 0.6 at 4 hours after dosing. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1410-1416DOI: (10.1016/j.jtcvs.2011.02.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Coagulation values throughout study for each group. A, Mean activated partial thromboplastin time (aPTT). B, Mean prothrombin time (PT). C, Mean anti-Xa. D, Mean fibrinogen. No AC, No anticoagulation; LMWH, low–molecular weight heparin; Dabig, dabigatran etexilate. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1410-1416DOI: (10.1016/j.jtcvs.2011.02.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Mean valve thrombus in milligrams (± SEM) for each group at 30 days. B, Mean valve thrombus for the 2 treatment arms at 30 days (P = .03), demonstrating that the animals that received dabigatran etexilate had the least valve thrombus development. C, Mean platelet deposition on valves for the 2 treatment arms. No AC, No anticoagulation. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1410-1416DOI: (10.1016/j.jtcvs.2011.02.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Postmortem photographs of explanted valves at 30 days. A, Representative valve from the no anticoagulation group. B, Representative valve from the enoxaparin group. C, Representative valve from the dabigatran etexilate group. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1410-1416DOI: (10.1016/j.jtcvs.2011.02.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Thromboelastographic data for the 3 groups. A, Mean R time (minutes), representing rate of initial fibrin formation. B, Mean K time (minutes), representing time to strong clot formation and cross-linking. C, Mean angle (degrees), representing speed of clot strengthening. D, Mean maximum amplitude (millimeters), representing final clot strength. NS, Not significant; No AC, no anticoagulation; LMWH, low–molecular weight heparin; Dabig, dabigatran etexilate. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 1410-1416DOI: (10.1016/j.jtcvs.2011.02.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions