Argatroban Dosing in Patients with Heparin-Induced Thrombocytopenia

Verme-Gibboney, Catherine; Hursting, Marcie J.

doi:10.1345/aph.1c443

Cited by 41 publications

(24 citation statements)

References 13 publications

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“…The dosing nomogram used in the former Calgary Health Region (see Appendix 1) was derived from the "Argatroban 911" study. 25 The safety of therapy was described in terms of the number of supratherapeutic aPTT results documented during therapy and the occurrence of major or minor bleeding.…”

Section: Methodsmentioning

confidence: 99%

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

Bates¹,

Griffin

Angel³

2009

CJHP

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Background: Argatroban is a direct thrombin inhibitor approved for the prophylaxis or treatment of thrombosis in patients with heparininduced thrombocytopenia (HIT). The product monograph does not guide clinicians beyond specifying the initial dose of 2 µg/kg per minute (or 0.5 µg/kg per minute for patients with hepatic impairment). Some authors have suggested that in the intensive care unit (ICU) and for patients with acute cardiac disease and those with renal or hepatic dysfunction, this dose may result in a supratherapeutic activated partial thromboplastin time (aPTT).

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Section: Methodsmentioning

confidence: 99%

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

Bates¹,

Griffin

Angel³

2009

CJHP

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“…In elderly patients at least 65 years old, age is not a significant determinant of argatroban dosage [55]. For dose titration, adjustments of 0.25-0.5 µg/kg/min appear reasonable for many patients, although smaller increments may be prudent at extremely low doses [64].…”

Section: Dosing Considerationsmentioning

confidence: 99%

Argatroban therapy in heparin-induced thrombocytopenia

Rice

Hursting

2008

Expert Review of Clinical Pharmacology

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Argatroban is a direct thrombin inhibitor approved for anticoagulation in heparin-induced thrombocytopenia (HIT; in several countries) and in patients with or at risk of HIT undergoing percutaneous coronary intervention (PCI; in the USA). HIT is a relatively common extreme prothrombotic condition. When HIT is reasonably suspected, an alternative anticoagulant should be promptly initiated. In historical controlled studies, argatroban reduced new thrombosis, mortality from thrombosis and the composite of death, amputation or thrombosis, without increasing bleeding. With intravenous infusion, advantages include short half-life, easy monitoring and elimination primarily by hepatobiliary (rather than renal) means. In patients undergoing PCI, argatroban with or without glycoprotein IIb/IIIa inhibition leads to high rates of procedural success with low bleeding risk. Herein we review argatroban therapy for HIT and for PCI.

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“…3,4 Also, modifying the dose is recommended for use in hepatically impaired patients with HIT. 5 Three regimens of argatroban in non-HIT patients with end stage renal disease on dialysis were evaluated. The regimens were allocated in 3 ways based on the combination of a bolus of 0.25 mg/kg or not and continuous infusion of 0.12 mg/kg/h or not.…”

mentioning

confidence: 99%

Management of Uremic Patients With Heparin-Induced Thrombocytopenia Requiring Hemodialysis

Matsuo

Wanaka²

2007

Clin Appl Thromb Hemost

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Medical records of 122 patients with suspected heparin-induced thrombocytopenia on dialysis were reviewed. Method of dialysis in heparin-induced thrombocytopenia patients with bleeding from various causes (including surgical interventions) and how to cope with blood access occlusion induced by heparin-induced thrombocytopenia were studied. Of 122 patients, 17 who met the criteria of >30% thrombocytopenia, clots in the extracorporeal circulation, positive for heparin/PF4 complex antibodies, and improvement from heparin-induced thrombocytopenia with the use of an alternative anticoagulant or another strategy for heparin-induced thrombocytopenia were chosen. Argatroban was uneventfully introduced in 12 patients having neither bleeding nor blood access failure. In all, 2 of 5 patients were treated with peritoneal dialysis. The others requiring a regional anticoagulant were given nafamostat mesilate. Argatroban as an alternative provides effectively anticoagulation in patients with heparin-induced thrombocytopenia on dialysis. In patients with heparin-induced thrombocytopenia with bleeding and its associated risk, nafamostat mesilate was an alternative. Peritoneal dialysis also was applied in cases of blood access failure due to heparin-induced thrombocytopenia.

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Argatroban Dosing in Patients with Heparin-Induced Thrombocytopenia

Cited by 41 publications

References 13 publications

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

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

Argatroban therapy in heparin-induced thrombocytopenia

Management of Uremic Patients With Heparin-Induced Thrombocytopenia Requiring Hemodialysis

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