Key result
Therapeutic argatroban doses were significantly lower in intensive care patients with heart failure (0.58 vs 0.97 microg/kg/min, P=0.042) and decreased as the number of failed organ systems increased.
Why the study?
Does the presence of heart failure or multiple organ system failure reduce argatroban dosing requirements in intensive care patients with suspected or previous heparin-induced thrombocytopenia?
Observational (n=65)
Does the presence of heart failure or multiple organ system failure reduce argatroban dosing requirements in intensive care patients with suspected or previous heparin-induced thrombocytopenia?
Absolute Event Rate: 0.58% vs 0.97%
p-value: p=0.042
Argatroban dosing requirements to achieve therapeutic anticoagulation are significantly reduced in intensive care patients with concurrent heart failure or multiple organ system failure.
May warrant lower argatroban starting doses in ICU patients with heart failure or organ failure; leaves open optimal titration strategies for prospective trials.
We retrospectively evaluated argatroban dosing patterns, clinical outcomes, and the effects of heart failure and multiple organ system failure on dosing requirements in 65 adult, intensive care patients administered argatroban anticoagulation for clinically suspected heparin-induced thrombocytopenia (n=56) or history of heparin-induced thrombocytopenia (n=9). Argatroban was initiated then titrated to achieve target activated partial thromboplastin times 1.5 to 3 times normal control (ie, 42-84 seconds). Overall, argatroban was initiated at 1.14+/-0.62 microg/kg/min (mean+/-SD) and administered for 11.4+/-9.5 days, with comparable dosing patterns between patients with suspected, versus previous, heparin-induced thrombocytopenia. Sixty-four (98.5%) patients achieved target activated partial thromboplastin times, typically following no or one dose adjustment. Therapeutic doses were lower in patients with, versus without, heart failure (0.58+/-0.28 vs 0.97+/-0.6 microg/kg/min, P= .042) and decreased as the number of failed organ systems increased from 1 to 2 to =3 (1.10+/-0.67 vs 0.87+/-0.47 vs 0.58+/-0.47 microg/kg/min, P= .008). From argatroban initiation until patient discharge or death, 11 (16.9%) patients (3 off argatroban) developed thromboembolic complications; 14 (21.5%) died (11 off argatroban, 7 from multiple organ system failure); and 1 (1.5%) required amputation. Nine patients (13.8%) experienced bleeding, none fatal. This experience suggests that argatroban administered at approximately 1 micro/kg/min provides adequate levels of anticoagulation in many intensive care unit patients with suspected or previous heparin-induced thrombocytopenia. Reduced doses are needed when heart failure or multiple organ system failure is present.
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Begelman et al. (2008) conducted an observational in Heparin-induced thrombocytopenia (suspected or history) (n=65). Argatroban vs. Patients without heart failure or multiple organ system failure was evaluated on Therapeutic argatroban dose requirements in patients with versus without heart failure (p=0.042). Therapeutic argatroban doses were significantly lower in intensive care patients with heart failure (0.58 vs 0.97 microg/kg/min, P=0.042) and decreased as the number of failed organ systems increased.
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