title: Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices.
abstract: BACKGROUND
  Patients receiving implantation of ventricular assist devices (VAD) suffer a high incidence of heparin induced thrombocytopenia (HIT); the occurrence of this condition is associated with increased complications and worse outcomes. We report our experience in the management of patients who were diagnosed with HIT either before (HITpre) or after (HITpost) implantation of VAD with argatroban, a direct thrombin inhibitor.
  
  
  METHODS
  This retrospective analysis assessed data of VAD patients diagnosed with HIT at Deutsches Herzzentrum Berlin between November 2005 and April 2009. Argatroban dose requirements, anticoagulation efficacy and adverse events (death, thromboembolism, bleeding) were recorded. Procedural success (discharge from the hospital, heart transplantation, or recovery of the failing heart) was also assessed.
  
  
  RESULTS
  Twenty-seven patients were identified (11 HITpre, 16 HITpost). Argatroban was effective in obtaining adequate anticoagulation with a reduced dose regimen (0.02-0.42 mcg/Kg/min starting dose; 0.02-1.5 mcg/Kg/min maintenance dose). We noted 5 thromboembolic complications (18%), 6 cases of major bleeding (22%) and 5 deaths (18%), all cause composite adverse end point occurring in 40% of patients. Procedural success was obtained in 81% of patients (92% HITpre, 69% HITpost). As compared to historical controls of patients treated with lepirudin in the period 2000-2005, results were significantly improved.
  
  
  CONCLUSIONS
  Argatroban anticoagulation is feasible in patients with HIT after VAD implantation, without increasing bleeding risk. Its impact in terms of survival should be reviewed also in the light of the technological improvements of assist devices.
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, Vita-Salute University, San Raffaele Hospital, Milan, Italy. pappalardo.federico@hsr.it
authors.forename: F
authors.initials: F
authors.lastname: Pappalardo
authors.forename: A M
authors.initials: AM
authors.lastname: Scandroglio
authors.forename: E
authors.initials: E
authors.lastname: Potapov
authors.forename: A
authors.initials: A
authors.lastname: Stepanenko
authors.forename: G
authors.initials: G
authors.lastname: Maj
authors.forename: T
authors.initials: T
authors.lastname: Krabatsch
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
authors.forename: A
authors.initials: A
authors.lastname: Koster
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D005240:Feasibility Studies; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000139:chemically induced / Q000188:drug therapy*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy*; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban