Efficacy and safety of argatroban in patients with heparin induced thrombocytopenia undergoing endovascular intervention for peripheral arterial disease.
OBJECTIVE
This study aimed to evaluate the efficacy and safety of argatroban during percutaneous interventions for peripheral arterial disease (PAD).


BACKGROUND
Endovascular interventions are commonly used in patients with peripheral arterial disease. Heparin is routinely administered during these procedures, but cannot be used in patients with a history of heparin-induced thrombocytopenia (HIT). Argatroban is an approved direct thrombin inhibitor for treatment of patients with HIT. There are currently few data on the efficacy and safety of argatroban during endovascular interventions for PAD.


METHODS
Patients who underwent endovascular interventions for PAD on argatroban between 2002 and 2005 were identified from out database. Efficacy was evaluated using a composite of death, urgent revascularization, and amputation, while safety was assessed by TIMI major bleeding during the index hospitalization.


RESULTS
A total of 48 patients undergoing lower extremity revascularization on argatroban were identified. Thirty two of these patients (67%) had antibody-confirmed HIT and the other 16 (33%) had suspected HIT. A mean dose of argatroban was 173.5 +/- 143 microg/kg bolus, followed by a 10.7 +/- 9.64 microg/kg/min infusion during the procedure. Twelve patients (25%) met the composite end point (two deaths, one urgent revascularization, nine amputations because of progressive peripheral arterial disease). TIMI major bleeding occurred in three (6%) patients.


CONCLUSIONS
In patients with confirmed or suspected HIT undergoing endovascular intervention for PAD, argatroban appears to be effective and safe. A larger study is warranted to confirm these findings from a single center.
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Suzanne J
SJ
Baron
Robert W
RW
Yeh
Ignacio
I
Cruz-Gonzalez
Josephine L
JL
Healy
Eugene
E
Pomerantsev
Joseph
J
Garasic
Douglas
D
Drachman
Kenneth
K
Rosenfield
Ik-Kyung
IK
Jang
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D000925:Anticoagulants / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000628:therapy*; D010875:Pipecolic Acids / Q000627:therapeutic use*; D012189:Retrospective Studies; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome
D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban