Key result
Argatroban was more effective than an increased dose of unfractionated heparin in achieving an aPTT target >45 s at 24 hours in critically ill heparin-resistant patients (86% vs 40%; p=0.0021).
Why the study?
To evaluate whether prophylactic anticoagulation using argatroban or an increased dose of UFH is effective in achieving targeted aPTT of more than 45 s in critically ill heparin-resistant patients.
Does argatroban improve the achievement and maintenance of targeted aPTT compared to an increased dose of unfractionated heparin in critically ill patients with heparin resistance?
RCT (n=42)
randomized
Does argatroban improve the achievement and maintenance of targeted aPTT compared to an increased dose of unfractionated heparin in critically ill patients with heparin resistance?
Absolute Event Rate: 86% vs 40%
p-value: p=0.0021
In critically ill patients with heparin resistance, argatroban is significantly more effective than increasing the dose of unfractionated heparin for maintaining adequate anticoagulation at 24 hours.
Argatroban may be preferred over heparin escalation for anticoagulation in heparin-resistant critically ill patients; provides RCT confirmation in this population.
The current study aims to evaluate whether prophylactic anticoagulation using argatroban or an increased dose of unfractionated heparin (UFH) is effective in achieving the targeted activated partial thromboplastin time (aPTT) of more than 45 s in critically ill heparin-resistant (HR) patients. Patients were randomized either to continue receiving an increased dose of UFH, or to be treated with argatroban. The endpoints were defined as achieving an aPTT target of more than 45 s at 7 h and 24 h. This clinical trial was registered on clinicaltrials.gov (NCT01734252) and on EudraCT (2012-000487-23). A total of 42 patients, 20 patients in the heparin and 22 in the argatroban group, were included. Of the patients with continued heparin treatment 55% achieved the target aPTT at 7 h, while only 40% of this group maintained the target aPTT after 24 h. Of the argatroban group 59% reached the target aPTT at 7 h, while at 24 h 86% of these patients maintained the targeted aPTT. Treatment success at 7 h did not differ between the groups (p = 0.1000), whereas at 24 h argatroban showed significantly greater efficacy (p = 0.0021) than did heparin. Argatroban also worked better in maintaining adequate anticoagulation in the further course of the study. There was no significant difference in the occurrence of bleeding or thromboembolic complications between the treatment groups. In the case of heparin-resistant critically ill patients, argatroban showed greater efficacy than did an increased dose of heparin in achieving adequate anticoagulation at 24 h and in maintaining the targeted aPTT goal throughout the treatment phase.
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Bachler et al. (2020) conducted an RCT in Heparin resistance in critically ill patients (n=42). Argatroban vs. Increased dose of unfractionated heparin (UFH) was evaluated on Achieving an aPTT target of more than 45 s at 24 h (p=0.0021). Argatroban was more effective than an increased dose of unfractionated heparin in achieving an aPTT target >45 s at 24 hours in critically ill heparin-resistant patients (86% vs 40%; p=0.0021).
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