Results of a consensus meeting on the use of argatroban in patients with heparin-induced thrombocytopenia requiring antithrombotic therapy – A European Perspective

Alatri, Adriano; Armstrong, Anna-Elina; Greinacher, Andreas; Koster, Andreas; Kozek‐Langenecker, Sibylle A.; Lancé, Marcus D.; Link, Andreas; Nielsen, Jørn Dalsgaard; Sandset, Per Morten; Spanjersberg, Alexander J.; Spannagl, Michael

doi:10.1016/j.thromres.2011.11.041

Cited by 68 publications

(66 citation statements)

References 75 publications

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“…In both conditions, when renal replacement therapy is required, the ACCP suggests argatroban or danaparoid over other nonheparin anticoagulants (Grade 2C). In such cases, regimens of either argatroban with PTT monitoring or reduced doses of danaparoid with anti-Xa activity monitoring are suggested by the British guidelines as indicated by a European Consensus Meeting [50].…”

Section: Guideline Recommendations For Hit Treatmentmentioning

confidence: 99%

Current management of heparin-induced thrombocytopenia

Cosmi

2015

Expert Review of Hematology

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Heparin-induced thrombocytopenia (HIT) is an immune adverse reaction to heparin (both unfractionated and low-molecular-weight), which is mediated by the formation of IgG antibodies against platelet factor 4-heparin complexes. The IgG/platelet factor 4 immunocomplexes activate platelets with resulting thrombocytopenia, which is not associated with bleeding, but with paradoxical life-threatening thrombotic complications, for coagulation activation. HIT diagnosis requires the assessment of pre-test clinical probability in combination with the measurement of platelet activating antibodies against platelet factor 4-heparin complexes with immunological and functional assays. When HIT is diagnosed, any form of heparin should be stopped and a non-heparin alternative anticoagulant should be started. Argatroban and danaparoid are currently the only drugs licensed for HIT, with different country availability. Bivalirudin is an option in cardiac surgery and procedures in HIT patients.

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Section: Guideline Recommendations For Hit Treatmentmentioning

confidence: 99%

Current management of heparin-induced thrombocytopenia

Cosmi

2015

Expert Review of Hematology

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“…Die Inzidenz einer heparininduzierten Thrombozytopenie (HIT) ist bei Kunstherzpatienten mit 7-10 % sehr hoch (bezieht sich auf VAD-Patienten, die mit unfraktioniertem Heparin behandelt werden [1,14]). Bei einem 4-T-Score ≥ 4 (4 T = "Thrombocytopenia, Timing, Thrombosis, absence of oTher explanation(s) for thrombocytopenia") wird die Applikation von unfraktioniertem Heparin oder NMH gestoppt und eine alternative Antikoagulation mit einem direkten synthetischen Thrombininhibitor wie Argatroban (Anfangsdosierung 0,05-0,1 µg/kg/min) oder Bivalirudin begonnen.…”

Section: Heparininduzierte Thrombozytopenie (Hit)unclassified

“…Bei einem 4-T-Score ≥ 4 (4 T = "Thrombocytopenia, Timing, Thrombosis, absence of oTher explanation(s) for thrombocytopenia") wird die Applikation von unfraktioniertem Heparin oder NMH gestoppt und eine alternative Antikoagulation mit einem direkten synthetischen Thrombininhibitor wie Argatroban (Anfangsdosierung 0,05-0,1 µg/kg/min) oder Bivalirudin begonnen. Patienten mit einem Score < 4 haben mit großer Wahrscheinlichkeit keine HIT [1]. Bei den empfohlenen Dosierungen ist antikoagulansabhängig die Leber-(Argatroban) bzw.…”

Section: Heparininduzierte Thrombozytopenie (Hit)unclassified

Intensivbehandlung von Kranken mit Linksherzersatz

Steinlechner¹,

Zimpfer

Schiferer³

et al. 2015

Med Klin Intensivmed Notfmed

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Apart from heart transplantation, implantation of a left ventricular assist device (LVAD) is the only established surgical treatment for therapy-refractory terminal left heart failure, The specific intensive care unit (ICU) management of these patients depends on the reason for the ICU admission and requires understanding of the characteristic hemodynamics of non-pulsatile LVADs as well as of the inherent problems. Knowledge about the specific features in hemodynamic monitoring, understanding of pump characteristics, management of anticoagulation and hemostasis and the handling of problems, such as right heart failure, aortic valve insufficiency and infections is essential. The management of unconscious LVAD patients can be challenging. It requires a sophisticated transthoracic and transesophageal echocardiography (TTE/TEE) examination, targeted laboratory diagnostics and consideration of possible alternative diagnoses. Professional interdisciplinary cooperation and exchange of current knowledge is crucial.

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“…Additionally, when used during angiography procedures, any oral anticoagulation the patient is on must be stopped before argatroban can be administered. For treatment of HIT, a dose of 0.5–2.0 μg/kg/min infusion is used 14 15. For PCI, loading doses are reported as ranging from 250 to 350 μg/kg given as an intravenous bolus followed by maintenance doses of 15–25 μg/kg/min via intravenous infusion 16–18.…”

Section: Case Seriesmentioning

confidence: 99%