title: Evaluation of 2 nomogram-based strategies for dosing argatroban in patients with known or suspected heparin-induced thrombocytopenia.
abstract: No study has compared 2 different dosing strategies for argatroban titration nor has any published nomogram demonstrated improvement in outcomes. This study was conducted to evaluate the effectiveness of 2 argatroban nomograms on reaching therapeutic anticoagulation. Patients treated with argatroban were separated into 2 sliding scale groups, percentage adjustments (PAs) and predefined dose increments (PDIs). The primary outcome was the time to reach a therapeutic activated partial thromboplastin time (aPTT). The average initial dose and dose to achieve a therapeutic aPTT were similar between the groups. There was also no difference in the number of dose changes. The time to reach a therapeutic aPTT was 2 hours shorter in the PDI compared to the PA group, 8 ± 4 hours versus 10 ± 4 hours, P = .015. This study demonstrates a significant time advantage associated with a PDI nomogram compared to a PA nomogram but no difference with respect to the number of rate changes.
authors: Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA parpino@partners.org.
authors: Paul A
authors: PA
authors: Arpino
authors: Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
authors: Adrienne J
authors: AJ
authors: Goeller
authors: Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
authors: Anthony
authors: A
authors: Fatalo
authors: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
authors: Elizabeth M
authors: EM
authors: Van Cott
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage*; D001120:Arginine / Q000031:analogs & derivatives; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D010875:Pipecolic Acids / Q000008:administration & dosage*; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D000991:Antithrombins; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban
keywords: anticoagulants; argatroban; direct thrombin inhibitors; nomogram; sliding scale