Argatroban use during pediatric interventional cardiac catheterization

Abstract

Argatroban is a synthetic direct thrombin inhibitor that does not interact with or induce heparin-dependent antibodies. It is approved for use in adults for prevention and treatment of thrombosis associated with heparin-induced thrombocytopenia (HIT). It has been administered safely in adults with HIT during coronary interventions. There are no reports of argatroban use for anticoagulation in pediatric patients. The present case describes the use of argatroban during coil embolization of a Fontan fenestration in a child with a history of HIT. The patient received a single bolus dose of 150 microg/kg of argatroban at the onset of the intervention. The fenestration was successfully occluded with a detachable coil. The activated clotting time (ACT) was > 200 sec throughout the procedure. The ACT returned to baseline 72 min after the bolus. No complications occurred. This case demonstrates the safe and successful use of argatroban during a transcatheter intervention in a pediatric patient with a history of HIT. The use of argatroban is promising for anticoagulation in children who require an alternative to heparin.

Heparin-induced thrombocytopenia in a pediatric patient receiving extracorporeal support and treated with argatroban

“…In the adult population, however, argatroban has been used successfully as an anticoagulant for brief extracorporeal cardiac support, mostly bypass support for cardiac surgery (5). Argatroban has been used for cardiac catheterization (6), and there is one reported case of its use in extracorporeal support in a pediatric patient (7). This case demonstrates that argatroban can be used to treat HIT and provide sufficient anticoagulation to maintain an ECMO and CRRT circuit.…”

Novel paediatric anticoagulants: a review of the current literature

“…Some of these reactions include fibrin generation, platelet aggregation, and activation of proteins involved in the various coagulation pathways such as protein C as well as FV, FVII, and FXIII [6,7]. It is well established that DTIs manifest more predictable effects as anticoagulants in comparison with heparin, as they are not readily neutralized by platelet factor 4 (PF4) and they do not bind to plasma proteins [8].…”

Thrombosis during infancy and childhood: what we know and what we do not know

“…Argartroban and lepirudin have been used successfully in special cases of children with cardiac disorders and heparininduced thrombocytopenia with doses extrapolated from adults. However, there are no large randomized trials studying the efficacy of these drugs in other children with thrombosis [124,125]. The adult dosage of argatroban is 2 mg/kg/minute, monitored by activated clotting time (ACT) of greater than 180 seconds for treatment of thrombosis.…”