Thrombocytopenia following heparin flush.
A total of 23 patients who developed heparin-induced thrombocytopenia following exposure to heparin solely due to intravascular catheter or filter flush were the subjects of prospective studies of argatroban therapy. Heparin doses were 10-13,000 U, with a mean exposure of 8+/-4 days. Following heparin-induced thrombocytopenia diagnosis and heparin cessation, 13 patients received argatroban (mean dose of 1.8+/-1.1 mg/kg/min for 5.5+/-3.9 days), achieving activated partial thromboplastin times of 63+/-23 seconds, and 10 historical control patients received no direct thrombin inhibitors. Platelet count recovered to a mean of 207+/-153 x 10(9)/L (n=12) after 5.5+/-3.9 days of argatroban therapy and to a mean of 127+/-63 x 10(9)/L (n=8) 5 days after baseline in the control group. A composite end point of death, amputation, or new thrombosis within 37 days occurred in five (38.5%) argatroban-treated patients and four (40%) controls. Death was the most common untoward outcome (approximately 30% of each group). No argatroban-treated patient and two (20%) control patients experienced new thrombosis. Major bleeding was comparable between groups. Heparin-induced thrombocytopenia can occur following minimal heparin exposure, including heparin flushes; in these patients, argatroban provides effective alternative anticoagulation as compared with historical controls.
McNulty
Iris
I
Massachusetts General Hospital Bulfinch 001, 55 Fruit Street, Boston, MA 02114, USA. imcnulty@partners.org
Katz
Eliezer
E
Kim
Karissa Y
KY
D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives; D002408:Catheters, Indwelling / Q000009:adverse effects; D002423:Cause of Death; D003937:Diagnosis, Differential; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D018579:Patient Selection; D010875:Pipecolic Acids / Q000627:therapeutic use*; D010976:Platelet Count; D011446:Prospective Studies; D012008:Recurrence; D013449:Sulfonamides; D007507:Therapeutic Irrigation; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome
D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban