title: Efficacy and safety of argatroban with or without glycoprotein IIb/IIIa inhibitor in patients with heparin induced thrombocytopenia undergoing percutaneous coronary intervention for acute coronary syndrome.
abstract: BACKGROUND
  There is limited experience with the use of argatroban in combination with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor in acute coronary syndrome (ACS) patients with heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by TIMI major bleeding) of the argatroban with or without a GPIIb/IIIa inhibitor during PCI. Among 102 consecutive ACS patients (71.6% unstable angina or NSTEMI and 28.4% STEMI) who received argatroban (239 +/- 104 microg/kg bolus, followed by a 17 +/- 11 microg/kg/min infusion) for confirmed or suspected HIT during PCI, 52 patients (51%) received a GPIIb/IIIa inhibitor simultaneously (86% integrilin, 10% tirofiban, 4% abciximab) and 50 patients (49%) did not.
  
  
  RESULTS
  There was no difference between the groups in the efficacy endpoint, which occurred in nine patients (17.3%) who received GPIIb/IIIa inhibitor and in eight patients (16%) who did not (P = 0.70). TIMI major bleeding occurred in three (5.8%) patients in the GPIIa/IIIb inhibitor group versus 0 (0%) patients in the argatroban alone group (P = 0.085).
  
  
  CONCLUSIONS
  In patients with suspected or confirmed HIT undergoing PCI for ACS, argatroban with or without GPIIb/IIIa appears to provide adequate anticoagulation and is well tolerated with a low rate of bleeding.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Gray/Bigelow 800, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.forename: Maria
authors.initials: M
authors.lastname: Sanchez-Ledesma
authors.forename: Suzanne J
authors.initials: SJ
authors.lastname: Baron
authors.forename: Josephine L
authors.initials: JL
authors.lastname: Healy
authors.forename: Hikari
authors.initials: H
authors.lastname: Watanabe
authors.forename: Masanori
authors.initials: M
authors.lastname: Osakabe
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000009:adverse effects*; D001120:Arginine / Q000031:analogs & derivatives; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010875:Pipecolic Acids / Q000009:adverse effects*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications*
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban