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Argatroban for Suspected Heparin-Induced Thrombocytopenia: Contemporary Experience at a Large Teaching Hospital

Baylor College of Medicine

Phuong H. Nguyen, PharmD

Baylor College of Medicine, The Methodist Hospital, Houston, TX

Amith Kodityal, BA

Baylor College of Medicine

Jeff Sherer, PharmD

The Methodist Hospital, Houston, TX

Marcie J. Hursting, PhD

Clinical Science Consulting, Potomac, MD

Lawrence Rice, MD

Baylor College of Medicine, The Methodist Hospital, Houston, TX, lrice{at}bcm.tmc.edu

Heparin-induced thrombocytopenia requires immediate alternative anticoagulation to prevent or treat thromboembolic complications. Argatroban was approved based on multiple-center studies from the 1990s, but subsequent changes in prevailing awareness, diagnostic testing and therapeutic strategies for heparin-induced thrombocytopenia might affect results of argatroban therapy. Charts were retrospectively reviewed from patients administered argatroban for suspected heparin-induced thrombocytopenia over 22 months at a single large university hospital. Twenty-seven patients, most in intensive care units, received a median 0.5 µg/kg/min argatroban over a median 5.5 days. Patients had isolated heparin-induced thrombocytopenia (n = 10), had heparin-induced thrombocytopenia with thrombosis (n = 9), or lacked active heparin-induced thrombocytopenia (n = 8) on final analysis. New thromboses (14.8%), progression of preexisting thromboses (0%), amputation secondary to heparin-induced thrombocytopenia (0%), death (22.2%), bleeding requiring transfusion (3.7%), and any bleeding (22.2%) compared favorably with older multiple-center reports. Deaths occurred mainly with preexisting multiple-organ failure. In contemporary "real world" use, argatroban provides safe and effective anticoagulation, strengthening the mandate to initiate alternative anticoagulation whenever heparin-induced thrombocytopenia appears likely.

Key Words: argatroban • heparin-induced thrombocytopenia • anticoagulants • direct thrombin inhibitors

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