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.
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.
Cruz-Gonzalez
Ignacio
I
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Gray/Bigelow 800, 55 Fruit Street, Boston, MA 02114, USA.
Sanchez-Ledesma
Maria
M
Baron
Suzanne J
SJ
Healy
Josephine L
JL
Watanabe
Hikari
H
Osakabe
Masanori
M
Yeh
Robert W
RW
Jang
Ik-Kyung
IK
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*
D000925:Anticoagulants; D010875:Pipecolic Acids; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban