Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin‐induced thrombocytopenia

Catheterization and Cardiovascular Interventions - Tập 57 Số 2 - Trang 177-184 - 2002
Bruce Lewis1,2, William Matthai1,3, Marc Cohen4, Jeffrey W. Moses5, Marcie J. Hursting6,1, Fred Leya2
1In accordance with the policy of the Journal, the designated authors disclose a financial or other interest in the subject discussed in this article.
2Loyola University Medical Center, Maywood, Illinois
3University of Pennsylvania Medical School, Philadelphia, Pennsylvania
4Hahnemann University Hospital, Philadelphia, Pennsylvania
5Lenox Hill Heart and Vascular Institute, New York, New York
6Clinical Science Consulting, Potomac, Maryland

Tóm tắt

AbstractHeparin‐induced thrombocytopenia (HIT) is an immune‐mediated syndrome associated with thrombosis. Alternative anticoagulation to heparin is needed for HIT patients during percutaneous coronary intervention (PCI). We evaluated argatroban, a direct thrombin inhibitor, for anticoagulation in this setting. Ninety‐one HIT patients underwent 112 PCIs while on intravenous argatroban (25 μg/kg/min [350 μg/kg initial bolus], adjusted to achieve an activated clotting time of 300–450 sec). Primary efficacy endpoints were subjective assessments of the satisfactory outcome of the procedure and adequate anticoagulation during PCI. Among patients undergoing initial PCIs with argatroban (n = 91), 94.5% had a satisfactory outcome of the procedure and 97.8% achieved adequate anticoagulation. Death (zero patients), myocardial infarction (four patients), or revascularization (four patients) at 24 hr after PCI occurred in seven (7.7%) patients overall. One patient (1.1%) experienced periprocedural major bleeding. For patients who had subsequent hospitalizations (mean separation of 150 days) for repeat PCI using argatroban anticoagulation (n = 21), there were no unsatisfactory outcomes. Overall, outcomes were comparable with those historically reported for heparin. Argatroban therefore is a reasonable anticoagulant option in this setting, where current options are limited. Cathet Cardiovasc Intervent 2002;57:177–184. © 2002 Wiley‐Liss, Inc.

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Thông tin xuất bản

Catheterization and Cardiovascular Interventions

Tập 57 Số 2

177-184

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