Argatroban for anticoagulation during cardiac surgery.
BACKGROUND
The aim of this study was to report our experience and review the published data on argatroban administration during adult cardiac surgery.


METHODS
The information on all reported cases of argatroban use in adults, during cardiac surgery was reviewed, including that of the patient described here. This analysis focused on patient characteristics, type of surgery, argatroban dosing schedule, monitoring of anticoagulation and outcomes.


RESULTS
Twenty-one cases have been reported. Fifteen patients underwent off-pump surgical procedures with the argatroban dose adjusted to maintain an activated clotting time (ACT) range between 200 and 300 s. Three intraoperative thrombi occurred in two patients when the ACT was <280 s. None had coagulopathy. Six cases reported the use of argatroban during on-pump cardiac surgery dosed to keep the ACT >400 s. Intraoperative thrombotic complications were not reported in this group; however, one clot in the pump was noted after the procedure when the ACT was between 300 and 350 s. All six cases required larger volumes of perioperative blood products and three had severe coagulopathy. Of the 21 cases, seven had an indication for continued anticoagulation following surgery. Four cases did not report further use of argatroban after surgery. Three patients received argatroban after surgery without complications. Recommendations for how to use argatroban during cardiac surgery are proposed.


CONCLUSIONS
Argatroban, with ACT monitoring, might be safely used for anticoagulation during cardiac surgery.
Martin
Monte E
ME
Division of Hematology and Medical Oncology, Department of Medicine, J.G. Brown Cancer Center, University of Louisville, Louisville, KY, USA.
Kloecker
Goetz H
GH
Laber
Damian A
DA
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D016903:Drug Monitoring; D004697:Endocarditis, Bacterial / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000601:surgery; D013350:Subclavian Vein; D013449:Sulfonamides; D013927:Thrombosis / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D014859:Warfarin; D006493:Heparin; D001120:Arginine; C031942:argatroban