Comparison of a predefined dose increment nomogram with a percentage adjustment nomogram in patients receiving argatroban therapy

Shah, Dhara; Shah, Kunal J.; Kakwani, Anjali; Bloomstein, Douglas

doi:10.1016/j.japh.2020.01.025

Cited by 1 publication

(3 citation statements)

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“…However, compared with the predefined increment cohort, percentage-adjusted patients spent more time in therapeutic range (46% vs 77.5%; P < 0.05) and less time in supratherapeutic range (17.8% vs 0%; P < 0.005). 15 Although these percentage-based titration strategies may attribute benefit in direct-thrombin inhibitor anticoagulation control, they may complicate care as pointed out by Arpino et al 16 In this comparison between percentage-adjusted and predefined increment strategies, no benefit was seen in the percentage-adjusted group with respect to time to therapeutic range. These authors hypothesized that the lack of benefit may be attributed to delays in dose adjustments because of the necessity for hand calculations.…”

Section: Discussionmentioning

confidence: 82%

“…5 Much like previously published literature, our data set also reflects increased anticoagulation control with a low incidence of safety-related events after the initiation of a standardized, nursing-driven bivalirudin titration nomogram. Shah et al 15 completed an evaluation to determine the optimal method of standardized titration. A comparison of a percentage-adjusted argatroban nomogram versus a predefined increment nomogram in patients with HIT was performed.…”

Section: Discussionmentioning

confidence: 99%

“…Shah et al 15 completed an evaluation to determine the optimal method of standardized titration. A comparison of a percentage-adjusted argatroban nomogram versus a predefined increment nomogram in patients with HIT was performed.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Newly Integrated Bivalirudin Titration Protocol in Patients With Mechanical Circulatory Support

Mitchell,

Sullinger,

Dyer

et al. 2023

Ann Pharmacother

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Background: Patients with cardiogenic shock or end-stage heart failure can be maintained on mechanical circulatory support (MCS) devices. Once a patient undergoes placement of a device, obtaining and maintaining therapeutic anticoagulation is vital. Guidelines recommend the use of institutional protocols to assist in dosing and titration of anticoagulants. Objective: The purpose of this study was to characterize the use of bivalirudin before and after the implementation of a standardized titration protocol in patients with MCS. Methods: A retrospective review of patients who received bivalirudin for MCS (VA ECMO [veno-arterial extracorporeal membrane oxygenation], Impella, or LVAD [left ventricular assist device]) before and after the implementation of the titration protocol into the electronic health record (EHR) was conducted. The primary outcome was to compare the proportion of therapeutic activated partial thromboplastin time (aPTT). Secondary outcomes included number of subtherapeutic and supratherapeutic aPTTs, incidence of bleeding and clotting events, bivalirudin titrations per day, and percentage of patients with therapeutic aPTT level. Results: A total of 100 patients were included (precohort = 67; postcohort = 33). The proportion of therapeutic aPTTs was significantly higher in the postcohort than that in the precohort (62% vs 48%; P < 0.001). The postcohort had 0% of patients failing to achieve therapeutic aPTT levels. The number of titrations per day was significantly lower in the postcohort, with 1.20 titrations per day versus 1.93 in the precohort ( P < 0.001). Conclusions: Implementation of the bivalirudin titration nomograms within the EHR significantly increased the number of therapeutic aPTTs, reduced the number of patients who never achieved a therapeutic aPTT, and reduced the required number of titrations per day.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%