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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:1348-1353.)
© 1999 American Heart Association, Inc.

Thrombosis

Comparison of the Antithrombotic Effect of PEG-Hirudin and Heparin in a Human Ex Vivo Model of Arterial Thrombosis

J. P. Bossavy; K. S. Sakariassen; K. Rübsamen; C. Thalamas; B. Boneu; Y. Cadroy

From the Service de Chirurgie Générale et Vasculaire (J.P.B.), the Laboratoire de Recherche sur l'Hémostase et la Thrombose (B.B., Y.C.), and the Centre d'Investigation Clinique (C.T.), Toulouse, France; the Department of Biology (K.S.S.), Division of General Physiology, University of Oslo, Oslo, Norway; and Knoll AG (K.R.), Ludwigshafen, Germany.

Correspondence and reprint requests to Y. Cadroy, Laboratoire de Recherche sur l'Hémostase et la Thrombose, CHU Purpan, 31059 Toulouse Cedex, France. E-mail cadroy.y{at}chu-toulouse.fr

Abstract—Polyethylene glycol (PEG)-hirudin is a derivative of hirudin with a long plasma half-life. We have compared the efficacy of PEG-hirudin with unfractionated heparin (UH) in preventing arterial thrombosis. Arterial thrombus formation was induced ex vivo in 12 healthy human volunteers by exposing a tissue factor–coated coverslip positioned in a parallel-plate perfusion chamber to flowing nonanticoagulated human blood drawn directly from an antecubital vein at an arterial wall shear rate of 2600 s^-1 for 3.5 minutes. PEG-hirudin, UH, or saline (as control) were administered ex vivo through a heparin-coated mixing device positioned proximal to the perfusion chamber. Platelet and fibrin deposition was quantified by immunoenzymatic measure of the P-selectin and D-dimer content of dissolved plasmin-digested thrombi, respectively. UH was administered to a plasma concentration of 0.35 IU/mL. This concentration prolonged the activated partial thromboplastin time from 32±1 seconds to 79±4 seconds (P<0.01). UH did not significantly prevent platelet deposition. However, fibrin deposition was reduced by 39% (P<0.05). PEG-hirudin in plasma concentrations of 0.5, 2.5, and 5 µg/mL prolonged the activated partial thromboplastin time to 48±2, 87±4, and 118±4 seconds, respectively. In contrast to UH, PEG-hirudin prevented both platelet and fibrin deposition in a dose-dependent manner with a >80% reduction at 5 µg/mL (P<0.01). Furthermore, the plasma level of PEG-hirudin required to significantly prevent fibrin deposition (0.5 µg/mL) corresponded to a much shorter prolongation of activated partial thromboplastin time (48±2 seconds) than that needed for UH (79±4 seconds). Thus, our results are compatible with the view that thrombin is greatly involved in recruitment of platelets in evolving thrombi, and that PEG-hirudin is an effective agent for preventing arterial thrombosis in a human ex vivo experimental model.

Key Words: hirudin • heparin • arterial thrombosis • flow • platelets

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