Argatroban Anticoagulation in Conjunction with Glycoprotein IIb/IIIa Inhibition in Patients Undergoing Percutaneous Coronary Intervention: An Open-Label, Nonrandomized Pilot Study

Jang, Ik–Kyung; Lewis, Bruce E.; Matthai, William H.; Kleiman, Neal S.

doi:10.1007/s11239-004-0171-2

Cited by 59 publications

(57 citation statements)

References 25 publications

(39 reference statements)

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“…In patients without HIT (n 5 152), argatroban alone or in combination with GP IIb/IIIa inhibitors during PCI was evaluated in a prospective cohort study without internal controls. 145 The incidence of the composite effi cacy outcome (death, Q-wave MI, and urgent revascularization) and major bleeding was acceptably low in both groups (0%-3%) 145 (Table S9).…”

Section: Bivalirudinmentioning

confidence: 95%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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Section: Bivalirudinmentioning

confidence: 95%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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Moores

et al. 2012

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“…In a study of 40 healthy subjects administered argatroban 2.5 lg/kg/min, pharmacokinetic parameters were not affected by age or sex (race was not considered as a covariate), argatroban clearance was 3.8-5.4 ml/min/kg and the elimination half-life was 39-51 min [39]. In a study of 152 non-HIT patients who underwent percutaneous coronary intervention using argatroban 15 lg/kg/min (that is, a substantially higher infusion dose than used in the noninterventional setting for HIT), race did not affect argatroban clearance, although the racial distribution was not reported [42,43]. In our study, the lesser median argatroban dose in Asian, as compared with African American or Hispanic, patients with HIT to achieve comparable aPTTs suggests the possibility of some interracial variations in argatroban pharmacokinetics; however, this remains to be prospectively evaluated in a larger patient sampling with pharmacokinetic assessments.…”

Section: Discussionmentioning

confidence: 97%

Dosing patterns and outcomes in African American, Asian, and Hispanic patients with heparin-induced thrombocytopenia treated with argatroban

Hursting

Jang

2008

J Thromb Thrombolysis

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We retrospectively evaluated dosing patterns and 37-day outcomes in argatroban-treated African American (n = 52), Asian (n = 13), and Hispanic (n = 14) patients with heparin-induced thrombocytopenia (HIT). The Asians required a lesser median dose (1.0 microg/kg/min) than the other groups (1.9 microg/kg/min, each) to achieve comparable activated partial thromboplastin times (medians: 61-69 s). Durations of therapy were similar (medians: 4.0-5.5 days). New thrombosis occurred in 11 (21%) African Americans, 1 (8%) Asian, and 1 (7%) Hispanic; of these 13 patients, 9 (69%) had baseline HIT-related thrombosis. Amputation occurred in 6 (12%) African Americans and 3 (21%) Hispanics; of these nine patients, 6 (67%) had diabetes. One (2%) African American and 1 (7%) Hispanic died from thrombosis. The composite of death due to thrombosis, amputation due to ischemic complications of HIT, or new thrombosis occurred in 14 (27%) African Americans, 1 (8%) Asian, and 4 (29%) Hispanics. Two (4%) African Americans and none others (0%) had major bleeding. These findings suggest that despite argatroban anticoagulation, African Americans and Hispanics may have worse outcomes in HIT than Asians. In minority patients with adverse HIT outcomes, baseline HIT-related thrombosis or diabetes is often present.

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“…In this situation, we should replace heparin with argatroban, which is a selective thrombin inhibitor. 17,18) In this patient, we measured AT-III activity on the second day of admission. Large amounts of unfractionated heparin can decrease AT III activity.…”

Section: )mentioning

confidence: 99%

A Case of Acute Myocardial Infarction With Repetitive Stent Thrombosis During Emergent Percutaneous Coronary Intervention Transient Decrease in Antithrombin III Activity and Heparin Resistance

et al. 2009

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SummaryA 59-year-old woman was admitted to our hospital for the treatment of an acute anterior myocardial infarction. She had a history of uncontrolled diabetes mellitus, hypertension, hyperlipidemia, obesity, and smoking. Coronary angiography revealed 90% stenosis with spontaneous dissection in the proximal portion of the left anterior descending artery. At this time, heparin was initiated for the first time. Although direct stenting (Be-stent, 3.0-18 mm) was performed for the culprit lesion, coronary dissection occurred at the left main trunk and additional stenting (Multi Link ZETA stent 3.5-15mm) was performed for the left main trunk. Soon after stenting, repetitive stent thrombosis occurred. Aspiration of the thrombus using an aspiration catheter was ineffective and repetitive angioplasty and intraaortic balloon pumping were required. Although we used 17,000 units of unfractionated heparin during the intervention, the activated coagulation time (ACT) was not prolonged (157 seconds). In the coronary care unit, the ACT and activated partial prothrombin time (aPTT) were not prolonged despite the use of large amounts of heparin (69,000 units in 2 days). Protein-S, protein-C, and hepaplastin testing were within normal limits and heparin-platelet factor IV complex antibody was not detected. In the acute phase, a decrease in the antithrombin III activity (65%) was noted and with administration of argatroban, prolongation of the aPTT was achieved. In the chronic phase, the decrease in antithrombin III activity and heparin resistance had improved spontaneously. It is important to recognize the existence of transient decreases in antithrombin III activity in the acute phase of myocardial infarction. (Int Heart J 2009; 50: 111-119)

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Argatroban Anticoagulation in Conjunction with Glycoprotein IIb/IIIa Inhibition in Patients Undergoing Percutaneous Coronary Intervention: An Open-Label, Nonrandomized Pilot Study

Abstract: Argatroban in combination with glycoprotein IIb/IIIa inhibition appears to provide adequate anticoagulation and be well tolerated with an acceptable bleeding risk for patients undergoing percutaneous coronary intervention. Additional studies are warranted.

Cited by 59 publications

References 25 publications

Treatment and Prevention of Heparin-Induced Thrombocytopenia

Treatment and Prevention of Heparin-Induced Thrombocytopenia

Dosing patterns and outcomes in African American, Asian, and Hispanic patients with heparin-induced thrombocytopenia treated with argatroban

A Case of Acute Myocardial Infarction With Repetitive Stent Thrombosis During Emergent Percutaneous Coronary Intervention Transient Decrease in Antithrombin III Activity and Heparin Resistance

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