title: Results of a consensus meeting on the use of argatroban in patients with heparin-induced thrombocytopenia requiring antithrombotic therapy - a European Perspective.
abstract: Argatroban has been introduced as an alternative parenteral anticoagulant for HIT-patients in several European countries in 2005. In 2009 a panel of experts discussed their clinical experience with argatroban balancing risks and benefits of argatroban treatment in managing the highly procoagulant status of HIT-patients. This article summarizes the main conclusions of this round table discussion. An ongoing issue is the appropriate dosing of argatroban in special patient groups. Therefore, dosing recommendations for different HIT-patient groups (ICU patients; non-ICU patients, paediatric patients, and for patients undergoing renal replacement therapies) are summarized in this consensus statement. Because of the strong correlation between argatroban dosing requirements and scores used to characterize the severity of illness (APACHE; SAPS, SOFA) suitable dosing nomograms are given. This consensus statement contributes to clinically relevant information on the appropriate use and monitoring of argatroban based on the current literature, and provides additional information from clinical experience. As the two other approved drugs for HIT, danaparoid and lepirudin are either currently not available due to manufacturing problems (danaparoid) or will be withdrawn from the market in 2012 (lepirudin), this report should guide physicians who have limited experience with argatroban how to use this drug safely in patients with HIT.
authors.affiliation: Department of Angiology, Centre Hospitalier Universitaire Vaudois, Av. Pierre Decker 5, CH-1011 Lausanne, Switzerland.
authors.forename: Adriano
authors.initials: A
authors.lastname: Alatri
authors.forename: Anna-Elina
authors.initials: AE
authors.lastname: Armstrong
authors.forename: Andreas
authors.initials: A
authors.lastname: Greinacher
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.forename: Sibylle A
authors.initials: SA
authors.lastname: Kozek-Langenecker
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Lancé
authors.forename: Andreas
authors.initials: A
authors.lastname: Link
authors.forename: Jørn D
authors.initials: JD
authors.lastname: Nielsen
authors.forename: Per M
authors.initials: PM
authors.lastname: Sandset
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Spanjersberg
authors.forename: Michael
authors.initials: M
authors.lastname: Spannagl
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects; D001120:Arginine / Q000031:analogs & derivatives; D004305:Dose-Response Relationship, Drug; D005060:Europe; D006405:Hematology / Q000592:standards*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D010875:Pipecolic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban