Argatroban in Thrombocytopenic Patients Sensitized to Circulating Protamine-Heparin Complexes

Wadowski, Patricia P.; Felli, Alessia; Schiferer, Arno; Panzer, Simon; Opfermann, Philipp; Dworschak, Martin; Holaubek, Caroline; Aliabadi-Zuckermann, Arezu; Steinlechner, Barbara

doi:10.1053/j.jvca.2017.03.023

Cited by 5 publications

(12 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, the actual number of patients undergoing argatroban anticoagulation for acquired heparin resistance may be higher than four. In addition, in one case series of four patients, argatroban was used in the setting of protamine-heparin complex induced thrombocytopenia [20]. Important outcomes, applied dosages and anticoagulation targets are listed in Table 2.…”

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 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.…”

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%

“…For studies included in the qualitative synthesis, the lower limit fell between 43-70s [19,21,23,25] and the upper limit between 60 and 100s [18,20,21,25]. In published case reports not included in the qualitative synthesis, the lower limit falls between 45 [43,55] and 80 s [56] and the higher limit between 60 [20,21,43,52,54,57,58] and 90 s [51,55,56,59]. In summary, most studies appear to target an aPTT corridor in the vicinity of 50-70 s. The optimal target interval may be in uenced by various factors such as recent operations, severe thrombocytopenia, the presence of signi cant bleeding, and recurrent major thromboembolic complications despite target range aPTT.…”

Section: Anticoagulation Targets and Monitoringmentioning

confidence: 99%

See 3 more Smart Citations

Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review

Geli

Capoccia

Maybauer

et al. 2021

J Intensive Care Med

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Anticoagulation Targets and Monitoringmentioning

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

View full text Add to dashboard Cite

show abstract

“…56,63 The association between thrombocytopenia and platelet-activating antiprotamine/heparin antibodies has also been reported in several case reports. 60,62 In addition, thromboembolic complications have been reported in patients with platelet-activating antibodies against protamine/heparin complexes, 60,65 supporting evidence from some cohort studies. 56,63 Of note, one recent case series reported on the use of argatroban in 4 patients with protamine/HIT.…”

Section: Clinical Presentation Of Antiprotamine/ Heparin Antibodiesmentioning

confidence: 71%

Drug-associated thrombocytopenia

Bakchoul

Marini

2018

Hematology

View full text Add to dashboard Cite

Many drugs have been implicated in drug-induced immune thrombocytopenia (DITP). Patients with DITP develop a drop in platelet count 5 to 10 days after drug administration with an increased risk of hemorrhage. The diagnosis of DITP is often challenging, because most hospitalized patients are taking multiple medications and have comorbidities that can also cause thrombocytopenia. Specialized laboratory diagnostic tests have been developed and are helpful to confirm the diagnosis. Treatment of DITP involves discontinuation of the offending drug. The platelet count usually starts to recover after 4 or 5 half-lives of the responsible drug or drug metabolite. High doses of intravenous immunoglobulin can be given to patients with severe thrombocytopenia and bleeding. Although in most cases, DITP is associated with bleeding, life-threatening thromboembolic complications are common in patients with heparin-induced thrombocytopenia (HIT). Binding of antiplatelet factor 4/heparin antibodies to Fc receptors on platelets and monocytes causes intravascular cellular activation, leading to an intensely prothrombotic state in HIT. The clinical symptoms include a decrease in platelet counts by >50% and/or new thromboembolic complications. Two approaches can help to confirm or rule out HIT: assessment of the clinical presentation using scoring systems and in vitro demonstration of antiplatelet factor 4/heparin antibodies. The cornerstone of HIT management is immediate discontinuation of heparin when the disease is suspected and anticoagulation using nonheparin anticoagulant. In this review, we will provide an update on the pathophysiology, diagnosis, and management of both DITP and HIT.

show abstract

Review of anticoagulation considerations in extracorporeal membrane oxygenation support

et al. 2023

View full text Add to dashboard Cite

Since its first success in 1975, extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency for pulmonary and cardiopulmonary bypass. Use in adults has increased exponentially since the early 2000s, but despite thousands of international cannulations using both veno‐arterial (VA) and veno‐venous (VV) ECMO, there are still significant hemocompatibility‐related adverse events. Current management of anticoagulation has been based on the Extracorporeal Life Support Organization guidance published in 2014 with recent updates published in 2022. Despite this guidance, there is still limited international consensus on how to manage anticoagulation in ECMO. For this review, we completed a comprehensive search of multiple electronic databases to identify studies pertaining to anticoagulation of adult patients on VV or VA‐ECMO. The highest priority was given to sources that were prospective, randomized, controlled studies, but in the absence of such resources, observational studies, retrospective uncontrolled studies, and case series/reports were considered for inclusion. This document serves to provide a comprehensive review of the current understanding of management pertaining to anticoagulation relating to ECMO.

show abstract

Argatroban in Thrombocytopenic Patients Sensitized to Circulating Protamine-Heparin Complexes

Cited by 5 publications

References 18 publications

Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review

Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review

Drug-associated thrombocytopenia

Review of anticoagulation considerations in extracorporeal membrane oxygenation support

Contact Info

Product

Resources

About