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DOI: 10.1055/s-0028-1086081
Clinical Experience of Argatroban in Germany
Publication History
Publication Date:
28 October 2008 (online)
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ABSTRACT
The main features of heparin-induced thrombocytopenia (HIT) are massive coagulation activation despite heparin anticoagulation and a drop in platelet count. A large proportion of patients with HIT develop thromboembolic complications if not treated with a nonheparin anticoagulant such as argatroban, danaparoid, or lepirudin. Whereas both lepirudin and danaparoid require dose adjustments or are contraindicated in patients with impaired renal function, argatroban can be used at normal therapeutic doses in these patients. Dose adjustments of argatroban are only necessary in patients with compromised liver function. Due to its short half-life, argatroban is an ideal anticoagulant for the perioperative phase. Argatroban typically is stopped 2 to 4 hours before surgery and restarted 2 to 12 hours after surgery. Argatroban is monitored by activated partial thromboplastin time test, but it also influences the prothrombin time test. When switching from argatroban to vitamin K antagonists, argatroban is discontinued when the international normalized ratio (INR) is > 4.0, and an additional INR is performed 4 hours after stopping argatroban. Other coagulation assays, including inhibitors (antithrombin, protein C, protein S), need to be interpreted with caution during argatroban therapy.
KEYWORDS
Heparin-induced thrombocytopenia - anticoagulants - argatroban - thrombin inhibitors
REFERENCES
- 1 Levy J H, Hursting M J. Heparin-induced thrombocytopenia, a prothrombotic disease. Hematol Oncol Clin North Am. 2007; 21 65-88
- 2 Warkentin T E. Heparin-induced thrombocytopenia: diagnosis and management. Circulation. 2004; 110 e454-e458
- 3 Warkentin T E, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126 311S-337S
- 4 Smythe M A, Warkentin T E, Stephens J L, Zakalik D, Mattson J C. Venous limb gangrene during overlapping therapy with warfarin and a direct thrombin inhibitor for immune heparin-induced thrombocytopenia. Am J Hematol. 2002; 71 50-52
- 5 Lo G K, Juhl D, Warkentin T E, Sigouin C S, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006; 4 759-765
- 6 Pouplard C, Gueret P, Fouassier M et al.. Prospective evaluation of the '4Ts' score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparin-induced thrombocytopenia. J Thromb Haemost. 2007; 5 1373-1379
- 7 Greinacher A, Volpel H, Janssens U et al.. Recombinant hirudin (lepirudin) provides safe and effective anticoagulation in patient44s with heparin-induced thrombocytopenia: a prospective study. Circulation. 1999; 99 73-80
- 8 Eichler P, Friesen H J, Lubenow N, Jaeger B, Greinacher A. Anti-hirudin antibodies in patients with heparin-induced thrombocytopenia treated with lepirudin: incidence, effects on aPTT, and clinical relevance. Blood. 2000; 96 2373-2378
- 9 Reddy B V, Grossman E J, Trevino S A, Hursting M J, Murray P T. Argatroban anticoagulation in patients with heparin-induced thrombocytopenia requiring renal replacement therapy. Ann Pharmacother. 2005; 39 1601-1605
- 10 Levine R L, Hursting M J, McCollum D. Argatroban therapy in heparin-induced thrombocytopenia with hepatic dysfunction. Chest. 2006; 129 1167-1175
- 11 Gosselin R C, Dager W E, King J H et al.. Effect of direct thrombin inhibitors, bivalirudin, lepirudin, and argatroban, on prothrombin time and INR values. Am J Clin Pathol. 2004; 121 593-599
- 12 Harder S, Graff J, Klinkhardt U et al.. Transition from argatroban to oral anticoagulation with phenprocoumon or acenocoumarol: effects on prothrombin time, activated partial thromboplastin time, and Ecarin Clotting Time. Thromb Haemost. 2004; 91 1137-1145
- 13 Sheth S B, DiCicco R A, Hursting M J, Montague T, Jorkasky D K. Interpreting the international normalized ratio (INR) in individuals receiving argatroban and warfarin. Thromb Haemost. 2001; 85 435-440
- 14 Gosselin R C, King J H, Janatpur K A, Dager W H, Larkin E C, Owings J T. Effects of pentasaccharide (fondaparinux) and direct thrombin inhibitors on coagulation testing. Arch Pathol Lab Med. 2004; 128 1142-1145
- 15 Harder S, Merz M, Klinkhardt U, Lorenz H, Koster A. Influence of argatroban on coagulation parameters in heparin-induced thrombocytopenia patients after cardiothoracic surgery. J Thromb Haemost. 2007; 5 1982-1984
Prof. Dr. Carl-Erik Dempfle
I Department of Medicine, University Hospital of Mannheim
Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany