Anticoagulation with Argatroban in Patients Undergoing Extracorporal Life Support System Therapy

Welp, Henryk; Sidermann, J.; Martens, SE; Gottschalk, Antje; Scherer, Mark

doi:10.1055/s-0038-1627974

Cited by 2 publications

(4 citation statements)

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“…Important outcomes, applied dosages and anticoagulation targets are listed in Table 2. Eight studies used aPTT [18][19][20][21][22][23][24][25] one study used ACT [26] and two studies used both parameters [27,28]. No information was available on the utilized monitoring parameter in two studies [29,30] Reports without control group [20][21][22][23][26][27][28][29][30] were not evaluated.…”

Section: Resultsmentioning

confidence: 99%

“…No information was available on the utilized monitoring parameter in two studies [29,30] Reports without control group [20][21][22][23][26][27][28][29][30] were not evaluated. Four retrospective observational studies [18,19,24,25] were assessed for risk of bias. Given the inherent lack of blinding in this type of studies, selection and performance bias were high throughout.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies used aPTT, [18][19][20][21][22][23][24][25] one study used ACT, 26 and two studies used both parameters. 27,28 No information was available on the utilized monitoring parameter in 2 studies.…”

Section: Resultsmentioning

confidence: 99%

“…Reports without control group [20][21][22][23][26][27][28][29][30] were not evaluated. Four retrospective observational studies 18,19,24,25 were assessed for risk of bias.…”

Section: Resultsmentioning

confidence: 99%

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Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review

Geli

Capoccia

Maybauer

et al. 2021

J Intensive Care Med

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Background: Heparin is the widely used anti-coagulation strategy for patients on extracorporeal membrane oxygenation (ECMO). Nevertheless, heparin-induced thrombocytopenia (HIT) and acquired anti-thrombin (AT) deficiency preclude the use of heparin requiring utilization of an alternative anticoagulant agent. Direct thrombin inhibitors are being proposed as potential alternatives with argatroban as one of the main agents. We aimed to review the evidence with regard to safety and efficacy of argatroban as a potential definitive alternative to heparin in the adult patient population undergoing ECMO support. Methods: A web-based systematic literature search was performed in Medline (PubMed) and Embase from inception until June 18, 2020. Results: The search identified 13 publications relevant to the target (4 cohort studies and 9 case series). Case reports and case series with less than 3 cases were not included in the qualitative synthesis. The aggregate number of argatroban treated patients on ECMO was n = 307. In the majority of studies argatroban was used as a continuous infusion without loading dose. Starting doses on ECMO varied between 0.05 and 2 μg/kg/min and were titrated to achieve the chosen therapeutic target range. The activated partial thormboplastin time (aPTT) was the anticoagulation parameter used for monitoring purposes in most studies, whereas some utilized the activated clotting time (ACT). Optimal therapeutic targets varied between 43-70 and 60-100 seconds for aPTT and between 150-210 and 180-230 seconds for ACT. Bleeding and thromboembolic complication rates were comparable to patients treated with unfractionated heparin (UFH). Conclusions: Argatroban infusion rates and anticoagulation target ranges showed substantial variations. The rational for divergent dosing and monitoring approaches are discussed in this paper. Argatroban appears to be a potential alternative to UFH in patients requiring ECMO. To definitively establish its safety, efficacy and ideal dosing strategy, larger prospective studies on well-defined patient populations are warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Reports without control group [20][21][22][23][26][27][28][29][30] were not evaluated. Four retrospective observational studies 18,19,24,25 were assessed for risk of bias.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review

Geli

Capoccia

Maybauer

et al. 2021

J Intensive Care Med

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Evaluation of clinical outcomes in patients treated with heparin or direct thrombin inhibitors during extracorporeal membrane oxygenation: a systematic review and meta-analysis

et al. 2022

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Background The number of patients treated with extracorporeal membrane oxygenation (ECMO) devices is increasing. Anticoagulation therapy is crucial to prevent thrombosis during ECMO therapy. Predominantly, heparin has been used as primary anticoagulant but direct thrombin inhibitors (DTI) have been established as alternatives. The aim of this systematic review and meta-analysis was to evaluate clinical outcomes in patients treated with heparin compared to different DTI during ECMO. Methods A systematic search was conducted. Full scientific articles were sought for inclusion if heparin anticoagulation was compared to DTI (argatroban/bivalirudin) in ECMO patients. Risk of bias was assessed by Newcastle Ottawa scale. Primary endpoint was in-hospital mortality. Bleeding events, thrombotic events, hours of ECMO support, days of hospital stay, percentage of time within therapeutic range and time to therapeutic range were extracted from full texts as secondary endpoints. Results were presented as Forrest-plots. GRADE was used for confidence assessment in outcomes. Results Systematic search identified 4.385 records, thereof 18 retrospective studies for a total of 1942 patients, complied with the predefined eligibility criteria:15 studies investigated bivalirudin and 3 studies investigated argatroban versus heparin. Risk of bias was high for most studies. In-hospital mortality, major bleeding events and pump-related thrombosis were less frequent in DTI group as compared to heparin [mortality—OR 0.69, 95% CI 0.54–0.86; major bleeding—OR 0.48, 95% CI 0.29–0.81; pump thrombosis—OR 0.55, 95% CI 0.40–0.76]. Additionally, percentage of time within therapeutic range was higher for DTI [SMD 0.54, 95% CI 0.14–0.94]. GRADE approach revealed a very low level of certainty for each outcome. Conclusion In this meta-analysis, DTI and especially bivalirudin showed beneficial effects on clinical outcomes in ECMO patients as compared to heparin. However, due to the lack of randomized trials, certainty of evidence is low. Trial Registration This systematic review and meta-analysis was prospectively registered at PROSPERO data base (reference number CRD42021237252). Graphical Abstract

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Anticoagulation with Argatroban in Patients Undergoing Extracorporal Life Support System Therapy

Cited by 2 publications

References 0 publications

Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review

Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review

Evaluation of clinical outcomes in patients treated with heparin or direct thrombin inhibitors during extracorporeal membrane oxygenation: a systematic review and meta-analysis

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