title: Safety and economic considerations of argatroban use in critically ill patients: a retrospective analysis.
abstract: BACKGROUND
  Heparin-induced thrombocytopenia (HIT) causes thromboembolic complications which threaten life and limb. Heparin is administered to virtually every critically ill patient as a protective measure against thromboembolism. Argatroban is a promising alternative anticoagulant agent. However, a safe dose which still provides effective thromboembolic prophylaxis without major bleeding still needs to be identified.
  
  
  METHODS
  Critically ill patients (n = 42) diagnosed with HIT at a tertiary medical center intensive care unit from 2005 to 2010 were included in this retrospective analysis. Patient records were perused for preexisting history of HIT, heparin dosage before HIT, argatroban dosage, number of transfusions required, thromboembolic complications and length of ICU stay (ICU LOS). Patients were allocated to Simplified Acute Physiology Scores above and below 30 (SAPS >30, SAPS <30), respectively. For calculations, patients (n = 19) without previous history of HIT were compared to patients (n = 23) with a history of HIT before initiation of argatroban.
  
  
  RESULTS
  The mean initial argatroban dosage was below 0.4 mcg/kg/min regardless of SAPS score. Maintenance dosage had to be increased in patients with SAPS <30 to 0.54 ± 0.248 mcg/kg/min (p >0.05) to achieve effective anticoagulation. No thromboembolic complications were encountered. Argatroban had to be discontinued temporarily in 16 patients for a total of 57 times due to diagnostic or surgical procedures, supratherapeutic aPTT and bleeding without increasing the number of transfusions. A history of HIT was associated with a shorter ICU LOS and significantly reduced transfusion need when compared to patients with no history of HIT. Cost calculation favour argatroban due to increased transfusion needs during heparin administration and increase ICU LOS.
  
  
  CONCLUSIONS
  Argatroban can be used at doses < 0.4 mcg/kg/min without an increase in transfusion requirements and at a reduced overall treatment cost compared to heparin.
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. Se-Chan.Kim@ukb.uni-bonn.de.
authors: Se-Chan
authors: SC
authors: Kim
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. nicole.tran@gmx.de.
authors: Nicole
authors: N
authors: Tran
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. Jens-Christian.Schewe@ukb.uni-bonn.de.
authors: Jens-Christian
authors: JC
authors: Schewe
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. Olaf.Boehm@ukb.uni-bonn.de.
authors: Olaf
authors: O
authors: Boehm
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. Maria.Wittmann@ukb.uni-bonn.de.
authors: Maria
authors: M
authors: Wittmann
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. Ingo.Graeff@ukb.uni-bonn.de.
authors: Ingo
authors: I
authors: Graeff
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. Andreas.Hoeft@ukb.uni-bonn.de.
authors: Andreas
authors: A
authors: Hoeft
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. Georg.Baumgarten@ukb.uni-bonn.de.
authors: Georg
authors: G
authors: Baumgarten
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001120:Arginine / Q000031:analogs & derivatives; D016638:Critical Illness / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control; D006493:Heparin / Q000009:adverse effects / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D008875:Middle Aged; D010875:Pipecolic Acids / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D012189:Retrospective Studies; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000175:diagnosis / Q000191:economics; D013923:Thromboembolism / Q000191:economics / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban