Key result
Argatroban use during ECMO therapy resulted in a lower average cost per course compared to heparin ($7,091.98 vs $15,323.49; P=0.15), without an increased risk of adverse events.
Why the study?
The cost-effectiveness of argatroban compared to heparin during ECMO therapy was not well evaluated.
Does argatroban reduce the total cost of anticoagulant therapy compared to heparin in adult patients on ECMO?
Cohort (n=35)
No
Does argatroban reduce the total cost of anticoagulant therapy compared to heparin in adult patients on ECMO?
Absolute Event Rate: 7091.98% vs 15323.49%
p-value: p=0.15
Argatroban may be a more cost-effective anticoagulation strategy than heparin for adult patients on ECMO, without increasing the risk of adverse events.
Argatroban may be cost-effective in low-antithrombin ECMO patients without added risk; leaves open need for prospective trials before practice change.
Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared to heparin during extracorporeal membrane oxygenation (ECMO) therapy. Methods: This was a retrospective study of patients who received argatroban or heparin infusions with ECMO therapy at a community hospital between January 1, 2017 and June 30, 2018. Adult patients who received heparin or argatroban for at least 48 hours while on venovenous (VV) or venoarterial (VA) ECMO were included. Patients with temporary mechanical circulatory assist devices were excluded. Each continuous course of anticoagulant exposure that met the inclusion criteria was evaluated. The primary endpoint was the total cost of anticoagulant therapy for heparin versus argatroban, including all administered study drugs, blood or factor products, and associated laboratory tests. Secondary endpoints included safety and efficacy of anticoagulation with each agent during ECMO. Documentation of bleeding events, circuit clotting, and ischemic events were noted. Partial thromboplastin time (PTT) values were evaluated for time to therapeutic range and percentage of therapeutic PTTs. Results: A total of 11 courses of argatroban and 24 courses of heparin anticoagulation were included in the study. The average cost per course of argatroban was less than the average cost per course of heparin ($7,091.98 vs $15,323.49, respectively; P value = 0.15). Furthermore, argatroban was not associated with an increased incidence of bleeding, thrombotic, or ischemic events. Conclusion: Argatroban may be more cost-effective during ECMO therapy in patients with low antithrombin III levels without increased risk of adverse events.
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Cho et al. (2019) conducted a cohort in Extracorporeal membrane oxygenation (ECMO) (n=35). Argatroban vs. Heparin was evaluated on Total cost of anticoagulant therapy (p=0.15). Argatroban use during ECMO therapy resulted in a lower average cost per course compared to heparin ($7,091.98 vs $15,323.49; P=0.15), without an increased risk of adverse events.
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