A case series describing the use of argatroban in patients on extracorporeal circulation.
Anticoagulation for extracorporeal life support (ECLS) is routinely achieved using heparin, which can be difficult in patients suspected of having heparin-induced thrombocytopenia. We describe a case series of five patients in which we used argatroban, a direct thrombin inhibitor, as an alternative to heparin for systemic anticoagulation during ECLS in patients suspected to have heparin-induced thrombocytopenia. Argatroban was used to achieve target systemic anticoagulation for activate clotting times between 210 and 230. Duration of argatroban use while on ECLS ranged from 6 to 184 hours. Argatroban dosage ranged from 0.2 to 3.5 microg/kg/min. Activated clotting times showed good agreement with aPTT. In conclusion, we illustrate that argatroban is a reasonable alternative to heparin anticoagulation for patients requiring ECLS.
Critical Care Medicine, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan 48109, USA.
Timothy
T
Cornell
Polly
P
Wyrick
Geoffrey
G
Fleming
Deborah
D
Pasko
Yong
Y
Han
Joseph
J
Custer
Jonathan
J
Haft
Gail
G
Annich
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D002303:Cardiac Output, Low / Q000150:complications / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005112:Extracorporeal Circulation; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy; D012189:Retrospective Studies; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications; D016896:Treatment Outcome; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban