Managing argatroban in heparin‐induced thrombocytopenia: A retrospective analysis of 729 treatment days in 32 patients with confirmed heparin‐induced thrombocytopenia

How to dose and monitor argatroban for treatment of HIT

“…[9][10][11] Marchetti and colleagues (senior author, Prof. Lorenzo Alberio) have performed a detailed analysis of 32 patients with HIT managed at Lausanne University Hospital (Switzerland) during a 4½-year period ending February 2019. 12 HIT diagnosis was secure based upon positive testing by two immunoassays and a positive heparin-induced platelet aggregation test; moreover, 15/32 (46.9%) patients presented with complicating thrombosis, consistent with expected HIT thrombosis rates. 1,2 These authors examined such issues as: initial argatroban dosing; magnitude of dosing adjustments; dosing adjustments with different types of liver dysfunction (hepatocellular, hepatobiliary, both); timing of blood sampling for monitoring after initiating argatroban and following subsequent dose adjustments; type of monitoring (APTT versus thrombin time versus commercial plasma argatroban level); and target international normalized ratio (INR) during argatroban/vitamin K antagonist (VKA) overlap (as argatroban substantially raises INR levels 4 ), among others.…”

“…Marchetti and colleagues (senior author, Prof. Lorenzo Alberio) have performed a detailed analysis of 32 patients with HIT managed at Lausanne University Hospital (Switzerland) during a 4½‐year period ending February 2019 12 . HIT diagnosis was secure based upon positive testing by two immunoassays and a positive heparin‐induced platelet aggregation test; moreover, 15/32 (46.9%) patients presented with complicating thrombosis, consistent with expected HIT thrombosis rates 1,2 .…”

Combinations of rapid immunoassays for a speedy diagnosis of heparin‐induced thrombocytopenia

“… 1 Consequently, it is essential to have a rapid and accurate diagnostic approach 4 to guide clinical management of patients with suspected HIT and accurately identify those who will need to be switched to non‐heparin anticoagulants, such as argatroban or danaparoid. 24 , 25 , 26 , 27 We have recently published our original Lausanne algorithm, 17 which is based on the Bayesian use of the 4T score 5 and two sequential rapid IA (CLIA and PaGIA) for anti‐PF4/heparin antibodies. This algorithm is able to accurately predict or exclude HIT in more than 95% of patients evaluated for suspected HIT, with a laboratory turnaround time of ≤1 h. 4 , 17 …”

“…While unrecognized HIT is linked with high morbidity and mortality, alternative non‐heparin anticoagulants are expensive and associated with a high bleeding rate 1 . Consequently, it is essential to have a rapid and accurate diagnostic approach 4 to guide clinical management of patients with suspected HIT and accurately identify those who will need to be switched to non‐heparin anticoagulants, such as argatroban or danaparoid 24–27 . We have recently published our original Lausanne algorithm, 17 which is based on the Bayesian use of the 4T score 5 and two sequential rapid IA (CLIA and PaGIA) for anti‐PF4/heparin antibodies.…”

“…1 Consequently, it is essential to have a rapid and accurate diagnostic approach 4 to guide clinical management of patients with suspected HIT and accurately identify those who will need to be switched to non-heparin anticoagulants, such as argatroban or danaparoid. [24][25][26][27] We have recently published our original Lausanne algorithm, 17 which is based on the Bayesian use of the 4T score 5 and two sequential rapid IA (CLIA and PaGIA) for anti-PF4/heparin antibodies. This algorithm is able to accurately predict or exclude HIT in more than 95% of patients evaluated for suspected HIT, with a laboratory turnaround time of ≤1 h. 4,17 We set out to evaluate the diagnostic accuracy of two other rapid IA for detecting anti-PF4/heparin antibodies, the STic Expert (a LFIA) 14 and the HemosIL HIT-Ab (PF4-H) (a LIA), 15 because our algorithm incorporated the PaGIA, 12 a manual, semi-quantitative assay, which may be difficult to interpret.…”