Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective studyReport as inadecuate




Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective study - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 14:R90

First Online: 20 May 2010Received: 19 January 2010Revised: 21 April 2010Accepted: 20 May 2010

Abstract

IntroductionHeparin-induced thrombocytopenia HIT is a serious, prothrombotic, immune-mediated adverse reaction triggered by heparin therapy. When HIT is diagnosed or suspected, heparins should be discontinued, and an alternative, fast-acting, parenteral, nonheparin anticoagulation such as argatroban should be initiated. Limited and inconsistent data exist about dosing of argatroban in intensive care unit ICU patients with critical illnesses.

MethodsRetrospective analysis of 12 ICU patients with multiple organ dysfunction syndrome MODS treated with argatroban for suspected or diagnosed HIT.

ResultsThe 12 ICU patients with a mean platelet count of 46,000 ± 30,310 had a mean APACHE II score of 26.7 ± 7.8 on ICU admission and a mean SAPS II score of 61.5 ± 16.3 on the first day of argatroban administration. A mean argatroban starting dose of 0.32 ± 0.25 μg-kg-min min, 0.04; max, 0.83 was used to achieve activated partial thromboplastin times aPTTs >60 sec or aPTTs of 1.5 to 3 times the baseline aPTT. Adjustment to aPTT required dose reduction in six 50% patients. Patients were treated for a mean of 5.5 ± 3.3 days. The final mean dose in these critically ill patients was 0.24 ± 0.16 μg-kg-min, which is about one eighth of the usually recommended dose and even markedly lower than the previously suggested dose for critically ill ICU patients. In all patients, desired levels of anticoagulation were achieved. The mean argatroban dose was significantly lower in patients with hepatic insufficiency compared with patients without hepatic impairment 0.10 ± 0.06 μg-kg-min versus 0.31 ± 0.14 μg-kg-min; P = 0.026. The mean argatroban dose was significantly correlated with serum bilirubin r = -0.739; P = 0.006.

ConclusionsICU Patients with MODS and HIT can be effectively treated with argatroban. A decrease in the initial dosage is mandatory in this patient population. Further studies are needed to investigate argatroban elimination and dosage adjustments for critically ill patients.

AbbreviationsAPACHE IIAcute Physiology and Chronic Health Evaluation II Score

aPTTactivated partial thromboplastin time

HIPAheparin-induced platelet activation

HITheparin-induced thrombocytopenia

ICUintensive care unit

INRInternational Normalized Ratio

MELD scoreModel of End Stage Liver Disease score

MODSmultiple organ dysfunction syndrome

SAPS IISimplified Acute Physiology Score.

Electronic supplementary materialThe online version of this article doi:10.1186-cc9024 contains supplementary material, which is available to authorized users.

An erratum to this article is available at http:-dx.doi.org-10.1186-cc11251.

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Author: Bernd Saugel - Veit Phillip - Georg Moessmer - Roland M Schmid - Wolfgang Huber

Source: https://link.springer.com/



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