Argatroban Anticoagulation in Patients With Heparin-Induced Thrombocytopenia

Abstract

Argatroban therapy, compared with historical control, improves outcomes, particularly new thrombosis and death due to thrombosis, in patients with heparin-induced thrombocytopenia.

Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review

“…The argatroban approval trials 55,56 performed in the 1990s enrolled patients on the basis of clinical suspicion of HIT alone (without requirement for a positive test for HIT antibodies), and although the frequency of antibody-positive status was reported to be only 57% in 1 of the studies, 55 the thrombotic event rate has not (to the best of our knowledge) been reported for the subgroup of patients likely to have had HIT on the basis of serologic detection of HIT antibodies. The aforementioned study by Kang et al 5 reported a thrombotic rate of 25% for patients treated with either danaparoid or argatroban but did not specify which patients with laboratory-confirmed HIT were treated with argatroban.…”

Heparin-Induced Thrombocytopenia

“…Compared with historical controls, argatroban was associated with reduced thrombotic events (relative risk reduction, 0.44 to 0.62). 4,16 The starting dose should be reduced by 75% in a patient with significant liver dysfunction because argatroban undergoes hepatobiliary excretion. Prolongation of the INR by argatroban is considerably greater than that observed with lepirudin, 17 which complicates argatrobanwarfarin overlap; this underscores the importance of postponing warfarin pending substantial resolution of HIT (to avoid warfarin-induced microvascular thrombosis).…”

Clinical Experience with Argatroban for Heparin-Induced Thrombocytopenia in a Large Teaching Hospital

“…6 However, the end points of death and amputation did not differ significantly between argatroban-treated patients and historical controls. 4,5 Furthermore, major bleeding rates did not differ between these 2 groups.…”

“…24 Major bleeding was defined as retroperitoneal or intracranial bleeding, bleeding into a prosthetic joint, decrease in hemoglobin of 20 g/L or more, and/or clinically evident bleeding requiring transfusion of 2 units or more of packed red blood cells. 4,5 All other bleeding was considered minor.…”

“…4,5 In those studies, thrombocytopenia was defined as a platelet count less than 100 × 10 9 /L or a 50% decline from baseline, excluding all other causes. A positive HIT assay was not required for enrolment in either study.…”