Relocation of the Internal Mammary Artery Graft in a Case of Coronary-Subclavian Steal

Abstract

Argatroban may be useful as an anticoagulant in the field of cardiovascular surgery as a substitute for heparin, without causing any post-surgery bleeding complication, or influencing the fibrinolytic activities or platelet functions.

Argatroban Anticoagulation in Renal Dysfunction: A Literature Analysis

“…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).…”

“…Data are available on both dosing and safety of argatroban in adults requiring RRT in 8 prospective studies [23,24,25, 27, 28,30,31,32], 2 retrospective studies [22, 33], and 10 case series or reports [16,36,37,38,39,41,42,43, 46, 47] (table 7). In these publications, a total of 253 argatroban-treated patients, including 82 with suspected, confirmed, or previous HIT and 82 with antithrombin deficiency, were presented.…”

“…In one study [25], an initial bolus of 200 µg/kg (assuming a 50-kg patient) was given followed by a continuous infusion (dose not reported), and in a crossover study [30], a 250 µg/kg bolus alone and a 2 µg/kg/min infusion with or without a 250 µg/kg bolus were evaluated. In the other studies [23, 24, 27, 28, 31, 32], argatroban was administered solely as a continuous infusion. Overall, the infusion doses varied from a low of 0.02–0.06 µg/kg/min in some cardiovascular surgery patients [27, 32] to a high of 5–8.3 µg/kg/min in the oldest publications [23, 24].…”

“…In the other studies [23, 24, 27, 28, 31, 32], argatroban was administered solely as a continuous infusion. Overall, the infusion doses varied from a low of 0.02–0.06 µg/kg/min in some cardiovascular surgery patients [27, 32] to a high of 5–8.3 µg/kg/min in the oldest publications [23, 24]. Dose adjustments were typically made to achieve target aPTT ratios, relative to control or baseline, of 1.5–2.0 [25], 2.5 [24], or 3 [31, 32], or target ACTs of >140 [30], 150–200 [27], or 180–200 s [28].…”

“…In prospective studies in patients without HIT, no circuit thrombosis occurred in 10 patients with chronic renal failure [24]; small clots were observed in the filter in 4 patients with acute renal failure [27]; mild-to-moderate clotting was noted in the hemofilter of 2 of 7 patients with acute renal failure, although no membrane change was required [7], and in 13 patients with end-stage renal disease, 1 of a total of 38 dialysis sessions was shortened because of circuit clot formation, and average Kt/V was 1.5–1.6 [30]. In prospective studies in patients with HIT, dialysis was carried out smoothly in each of 5 patients with acute renal failure [25]; there was no evidence of clots in the dialyzer in each of 5 patients with end-stage renal disease [31], and no filter system exchange due to premature filter thrombosis was needed during intermittent hemodialysis in 10 patients with acute renal failure [32].…”