Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective study.
Crit Care. 2010 May 20;14(3):R90
Authors: Saugel B, Phillip V, Moessmer G, Schmid RM, Huber W
ABSTRACT: INTRODUCTION: Heparin-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, non-heparin anticoagulation such as argatroban should be initiated. There is limited and inconsistent data about dosing of argatroban in intensive care unit (ICU) patients with critical illness. METHODS: Retrospective analysis of 12 ICU patients with multiple organ dysfunction syndrome (MODS) treated with argatroban for suspected or diagnosed HIT. RESULTS: The 12 ICU patients with mean platelet count 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 first day of argatroban administration. A mean argatroban starting dose of 0.32+/-0.25 ug/kg/min (min 0.04; max 0.83) was used to achieve activated partial thromboplastin times (aPTTs) > 60sec or aPTTs of 1.5-3 times the baseline aPTT. Adjustment to aPTT required dose reduction in 6 patients (50%). 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 ug/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 to patients without hepatic impairement (0.10+/-0.06 ug/kg/min vs. 0.31+/-0.14 ug/kg/min; P=0.026). The mean argatroban dose was significantly correlated with serum bilirubin (r=-0.739; P=0.006). CONCLUSIONS: ICU Patients with MODS and HIT can be effectively treated using 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.
PMID: 20487559 [PubMed - as supplied by publisher]