Heparin-induced thrombocytopenia in a pediatric patient receiving extracorporeal membrane oxygenation managed with argatroban???

Scott, L. Keith; Grier, Laurie; Conrad, Steven A.

doi:10.1097/01.pcc.0000231946.88688.07

Cited by 23 publications

(23 citation statements)

References 13 publications

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“…Our final literature set (table 1) therefore comprised 34 publications that together described argatroban anticoagulation in 644 patients with varying degrees of renal function and with either suspected, confirmed, or previous HIT (5 prospective studies [10, 25, 29, 31, 32], 3 retrospective studies [22, 34, 35], 15 case reports [36,37,38,39,40,41,42,43,44,45,46, 48, 49]); antithrombin deficiency (1 retrospective study [33], 2 case reports [16, 47]), or neither HIT nor antithrombin deficiency (6 prospective studies [5, 23, 24, 27, 28, 30]). Overall, the data were prospective in 185 patients (70 with suspected, confirmed, or previous HIT), retrospective in 430 patients (80 with antithrombin deficiency and 350 with suspected, confirmed, or previous HIT), and anecdotal in 29 patients (26 with suspected, confirmed, or previous HIT and 2 with antithrombin deficiency).…”

Section: Resultsmentioning

confidence: 99%

“…No one had systemic thrombosis during hemodialysis; 1 patient had clotting in the dialysis circuit; 1 patient had nonfatal bleeding that was multifactorial in origin. A case report [49] presented a 17-month-old patient with HIT who underwent successful continuous RRT and extracorporeal membrane oxygenation using argatroban anticoagulation. Argatroban doses of 1–2 µg/kg/min supported ACTs of 180– 200 s, and there was no bleeding complication.…”

Section: Resultsmentioning

confidence: 99%

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Argatroban Anticoagulation in Renal Dysfunction: A Literature Analysis

Hursting

Murray

2008

Nephron Clin Pract

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Background/Aims: Argatroban, a hepatically metabolized direct thrombin inhibitor, is approved for use in heparin-induced thrombocytopenia (HIT; several countries) and in antithrombin-deficient patients undergoing hemodialysis (Japan). This literature analysis aimed to determine the effects of renal function on argatroban pharmacokinetics, pharmacodynamics, and its therapeutic dose in HIT and to evaluate argatroban dosing and safety during renal replacement therapy (RRT) and in adults with renal dysfunction undergoing surgical or invasive procedures. Methods: A literature search identified 34 publications (12 prospective studies, 4 retrospective studies, 18 anecdotal reports) that together described 644 argatroban-treated patients (446 with HIT, 82 with antithrombin deficiency) with varying degrees of renal function. Pertinent data were extracted and summarized. Results: In pharmacokinetic studies (40 patients, overall), renal dysfunction exerted little or no clinically significant effects on argatroban pharmacokinetic parameters. For argatroban therapy in HIT, evidence existed that an initial 2 µg/kg/min dose was sometimes excessive; patients with hepatic dysfunction, irrespective of renal function, required reduced initial doses; lesser doses were required in combined hepatic and renal dysfunction than hepatic dysfunction, and for each 30 ml/min decrease in patient creatinine clearance, the therapeutic dose decreased ∼0.1–0.6 µg/kg/min. Argatroban was well tolerated and enabled RRT with little or no thrombotic or hemorrhagic complications. Experiences with argatroban in renally impaired patients undergoing procedures besides RRT were limited. Conclusion: Current literature suggests that argatroban is well tolerated and provides adequate anticoagulation in patients with renal dysfunction or failure, including individuals with HIT or antithrombin deficiency where anticoagulant options are limited.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Argatroban Anticoagulation in Renal Dysfunction: A Literature Analysis

Hursting

Murray

2008

Nephron Clin Pract

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“…There are limited data on their use in children undergoing extracorporeal circulation. 27,30,34 A study comparing heparin and argatroban utilizing sham ECMO circuits demonstrated significantly less thrombin generation in the circuits with argatroban compared to heparin. 35 Although these data are intriguing and point to a potential role for DTI in ECMO, confirmation of this finding is required including clinical trials before DTI can be recommended as alternatives to standard therapy with heparin.…”

Section: Short-acting Agentsmentioning

confidence: 99%

New Anticoagulants in Children

Young

2008

Hematology

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Thromboembolic complications are increasing in children and the use of anticoagulation has seen a dramatic increase despite the lack of randomized clinical trials. The most widely used agents in children are heparin, low-molecular-weight heparins (LMWH), and warfarin. These agents, however, have significant limitations that are exaggerated in children. Novel anticoagulants such as direct thrombin inhibitors and the selective factor Xa inhibitor, fondaparinux, have been approved for use in adults and have properties that suggest they may be safer and more efficacious than the standard agents; however, until recently, publications using these agents in children were limited to case reports. Recently, clinical trials for two direct thrombin inhibitors, bivalirudin and argatroban, have been completed and a clinical trial of fondaparinux is under way. This review will compare the standard agents with the novel agents and briefly review the results of the clinical trials.

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“…For cardiac surgery with cardiopulmonary bypass (CPB), argatroban anticoagulation has been used on occasion 3 . Argatroban has also been used for noncardiac surgery indications and noncardiac surgery, extracorporeal life support 5,6 . However, to the best of our knowledge, there are only four previous case reports detailing argatroban's use in infants (<12 months of age) who survived cardiac surgery utilizing CPB 7–10 …”

Section: Introductionmentioning

confidence: 99%

“…3 Argatroban has also been used for noncardiac surgery indications and noncardiac surgery, extracorporeal life support. 5,6 However, to the best of our knowledge, there are only four previous case reports detailing argatroban's use in infants (<12 months of age) who survived cardiac surgery utilizing CPB. [7][8][9][10] We present an infant with double outlet right ventricle (DORV) and history of a systemic to pulmonary artery shunt (SPAS), protein C deficiency, a methylene-tetra-hydro-folate reductase (MTHFR) gene mutation, and HIT that required CPB for complete repair.…”

Section: Introductionmentioning

confidence: 99%