Effective anticoagulation by argatroban during immunoadsorption therapy for malignant rheumatoid arthritis with a high polymorphonuclear leukocyte elastase level.
Polymorphonuclear leukocyte elastase (PMNE) is a glycoprotein with a molecular weight of about 30000 and exists in 3 isozymes (1). It has a biological role in host defense mechanisms, but it sometimes induces abnormal blood coagulation and injury of the vascular intima (1,2). We were not able to obtain a satisfactory anticoagulant effect when using heparin during immunoadsorption therapy in a patient with malignant rheumatoid arthritis and high PMNE level, but found that argatroban, a selective antithrombin agent, produced satisfactory anticoagulation. This finding is interesting as far as the various pathologic roles of PMNE are attracting increasing clinical attention (1,2,3).
Suzuki
S
S
Department of Internal Medicine, Hyogo Prefectural Awaji Hospital, Japan.
Sakamoto
S
S
Koide
M
M
Kobayashi
H
H
Matsuo
M
M
Shimano
C
C
Matsuo
T
T
D000991:Antithrombins / Q000008:administration & dosage*; D001120:Arginine / Q000031:analogs & derivatives; D001172:Arthritis, Rheumatoid / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007164:Immunosorbents / Q000627:therapeutic use*; D019272:Leukocyte Elastase / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology*; D010196:Pancreatic Elastase / Q000378:metabolism*; D010875:Pipecolic Acids / Q000008:administration & dosage*; D013449:Sulfonamides
D000991:Antithrombins; D007164:Immunosorbents; D010875:Pipecolic Acids; D013449:Sulfonamides; D001120:Arginine; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase; C031942:argatroban