Role of argatroban during neurointerventional procedures in patients with heparin induced thrombocytopenia.
BACKGROUND
Currently, heparin is used routinely for anticoagulation during cerebral angiography and neurointerventional procedures. In patients with heparin sensitivity, however, heparin cannot be used. Therefore, an alternative method of anticoagulation is necessary to prevent clot formation during such procedures.


METHODS
Argatroban, a direct thrombin inhibitor, is used as an alternate to heparin for anticoagulation. It is indicated for treatment of heparin induced thrombocytopenia as well as for prophylaxis during percutaneous coronary intervention. There are no reports describing the protocols for its use during neurointerventional procedures. We report on a series of three patients where argatroban was used in a series of three patients who underwent endovascular interventional procedures.


RESULTS
Argatroban was given in a loading dosage of 4 μg/kg/min for 10 min followed by an infusion of 1.0 μg/kg/min. During the procedure, no procedural complications were reported. Activated thrombin time was used to monitor anticoagulation.


CONCLUSIONS
We describe here the use of argatroban as an alternate anticoagulant during such procedures, as well as outline our protocol for its administration.
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Ali
A
Alaraj
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Matthew
M
Tobin
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Daniel
D
Birk
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Victor
V
Aletich
D000925:Anticoagulants / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D001120:Arginine / Q000031:analogs & derivatives; D002533:Cerebral Angiography / Q000592:standards*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000592:standards*; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced
D000925:Anticoagulants; D000991:Antithrombins; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban
Intervention; Pharmacology; Standards; Technique