Efficacy and safety of argatroban in patients with acute respiratory distress syndrome and extracorporeal lung support

Abstract

BackgroundExtracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (pECLA) requires effective anticoagulation. Knowledge on the use of argatroban in patients with acute respiratory distress syndrome (ARDS) undergoing ECMO or pECLA is limited. Therefore, this study assessed the feasibility, efficacy and safety of argatroban in critically ill ARDS patients undergoing extracorporeal lung support.MethodsThis retrospective analysis included ARDS patients on extracorporeal lung support who received argatroban between 2007 and 2014 in a single ARDS referral center. As controls, patients who received heparin were matched for age, sex, body mass index and severity of illness scores. Major and minor bleeding complications, thromboembolic events, administered number of erythrocyte concentrates, thrombocytes and fresh-frozen plasmas were assessed. The number of extracorporeal circuit systems and extracorporeal lung support cannulas needed due to clotting was recorded. Also assessed was the efficacy to reach the targeted activated partial thromboplastin time (aPTT) in the first consecutive 14 days of therapy, and the controllability of aPTT values is within a therapeutic range of 50–75 s. Fisher’s exact test, Mann–Whitney U tests, Friedman tests and multivariate nonparametric analyses for longitudinal data (MANOVA; Brunner’s analysis) were applied where appropriate.ResultsOf the 535 patients who met the inclusion criteria, 39 receiving argatroban and 39 matched patients receiving heparin (controls) were included. Baseline characteristics were similar between the two groups, including severity of illness and organ failure scores. There were no significant differences in major and minor bleeding complications. Rates of thromboembolic events were generally low and were similar between the two groups, as were the rates of transfusions required and device-associated complications. The controllability of both argatroban and heparin improved over time, with a significantly increasing probability to reach the targeted aPTT corridor over the first days (p < 0.001). Over time, there were significantly fewer aPTT values below the targeted aPTT goal in the argatroban group than in the heparin group (p < 0.05). Both argatroban and heparin reached therapeutic aPTT values for adequate application of extracorporeal lung support.ConclusionsArgatroban appears to be a feasible, effective and safe anticoagulant for critically ill ARDS patients undergoing extracorporeal lung support.

Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation

“…The single center study supported that patients anticoagulated with argatroban had no difference in major or minor bleeding and had more goal aPTT values compared to UFH controls [43]. Multiple studies have shown that doses vary widely between adult and pediatric patients anticoagulated with argatroban on ECMO, thus careful monitoring is imperative to ensure optimal anticoagulation [43][44][45]. A literature analysis reviewed nine articles describing 34 patients anticoagulated with argatroban.…”

Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation

“…Experience and data regarding the use of DTIs for anticoagulation in ECMO patients is essentially limited to cases of HIT (35)(36)(37). Only a few studies have compared DTIs anticoagulation to standard UFH anticoagulation (38,39).…”

Extrakorporale Membranoxygenierung in der Thoraxchirurgie: die Sicht des Anästhesisten

“…Die Inzidenz an Blutungen und thrombembolischen Komplikationen unterschied sich nicht zwischen den verschiedenen Antikoagulanzien. Eine interessante Beobachtung war, dass die Patienten unter Argatroban das aPTT-Ziel schneller erreichten und als Ausdruck der besseren Steuerbarkeit stabiler im Zielkorridor waren [29].…”