Wednesday, November 7, 2007

Wednesday November 7, 2007
Argatroban anticoagulation in Critically Ill Patients


Since we are diagnosing more and more HIT (Heparin Induced Thrombocytopenia), Argatroban has entered into mainstream ICU care !

But care should be taken in prescribing Argatroban. See this important study published this year in The Annals of Pharmacotherapy regarding dosing of Argatroban for critically ill patients with multiple organ dysfunction (MODS) and suspected or proven heparin induced thrombocytopenia (HIT).

METHOD: Prospective observation of 24 consecutive patients with suspected HIT who were being anticoagulated with argatroban using 2 µg/kg/min in the first 5 patients and 0.2 µg/kg/min in the subsequent 19 patients.

RESULTS:



  • Infusion of argatroban 2 µg/kg/min over 4 hours caused bleeding complications in 3 patients as aPTT increased from 51 to 86 secs, and INR increased from 1.4 ± 0.4 to 2.5.
  • Infusion of argatroban 0.2 µg/kg/min over 4 hours provided sufficient anticoagulation without bleeding complications. The aPTT in this population increased from 44 ± 9 to 59 ± 13 seconds (p <>

Coagulation variables (aPTT, PT, INR) were significantly different between both dosing regimens after 4 hours of infusion.



CONCLUSIONS:
In critically ill patients with MODS, argatroban 2 µg/kg/min, as recommended by the manufacturer, resulted in extensive anticoagulation. A tenfold lower starting dose is sufficient and safe for effective anticoagulation in this specific patient population.




References: click to get abstract/article

1.
Argatroban Anticoagulation in Critically Ill Patients - The Annals of Pharmacotherapy: Vol. 41, No. 5, pp. 749-754.

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