Successful Use of Argatroban During the Third Trimester of Pregnancy: Case Report and Review of the Literature

Abstract

Direct thrombin inhibitors are commonly used anticoagulants in patients with known or suspected heparin-induced thrombocytopenia (HIT). All three direct thrombin inhibitors available in the United States-argatroban, bivalirudin, and lepirudin-are pregnancy category B drugs based on animal studies, but little data are available on the safety of these agents during human pregnancy. Whereas several case reports support the safe use of lepirudin, only one case report has been published with argatroban and none with bivalirudin. We describe a 26-year-old pregnant woman with portal vein thrombosis and thrombocytopenia treated with argatroban for possible HIT during her last trimester. An argatroban infusion was started at 2 microg/kg/minute during her 33rd week of pregnancy, with the dosage titrated based on the activated partial thromboplastin time; infusion rates ranged from 2-8 microg/kg/minute. Treatment continued until her 39th week of pregnancy, when labor was induced. Argatroban therapy was discontinued 7 hours before epidural anesthesia. The patient successfully delivered a healthy male newborn, devoid of any known adverse effects from argatroban. The infant was found to have a small ventricular septal defect and patent foramen ovale at birth, but it is unlikely that these were caused by argatroban since organogenesis occurs in the first trimester. Even though the cause of this patient's thrombocytopenia was later determined to be idiopathic thrombocytopenic purpura, this is an important case that adds to the literature on use of argatroban during pregnancy.

Treatment and Prevention of Heparin-Induced Thrombocytopenia

“…Lepirudin, Argatroban, and Fondaparinux: Data supporting the use of lepirudin, [168][169][170] argatroban, 171,172 and fondaparinux [173][174][175] to treat HIT during pregnancy are limited to case reports. The advantage of lepirudin is that it can be administered SC (it has been given in doses ranging from 25 mg bid to 125 mg bid; monitored by aPTT 2 h post injection).…”

ST‐elevation acute myocardial infarction in pregnancy: 2016 update

“…There are no published reports to date utilizing bivalirudin during pregnancy, but several case reports document the use of argatroban for the treatment of venous thromboembolism in those with HIT. 25,26 No adverse effects have been described in case reports. 25,26 Given the relatively limited data on the fetal effects of DTI, we recommend using argatroban only in those with HIT.…”

“…25,26 No adverse effects have been described in case reports. 25,26 Given the relatively limited data on the fetal effects of DTI, we recommend using argatroban only in those with HIT.…”

Małopłytkowość poheparynowa

“…Only a few reports describe the development of complications in pregnant women with congenital thrombophilia (mutation of factor V Leiden) [70] and/or antithrombin deficiency [71,72].…”