PMID- 25594496
OWN - NLM
STAT- MEDLINE
DCOM- 20151020
LR  - 20201209
IS  - 1098-9064 (Electronic)
IS  - 0094-6176 (Linking)
VI  - 41
IP  - 1
DP  - 2015 Feb
TI  - Efficacy of argatroban in critically ill patients with heparin resistance: a 
      retrospective analysis.
PG  - 61-7
LID - 10.1055/s-0034-1398382 [doi]
AB  - The patients who do not respond even to very high dosages of heparin are assumed 
      to suffer from heparin resistance. The aim of this study was to investigate 
      whether critically ill patients suffering from heparin resistance generally have 
      low antithrombin III (AT) levels, and if the direct thrombin inhibitor argatroban 
      in that case can be an effective option to achieve prophylactic anticoagulation. 
      The study was conducted at the Department for General and Surgical Intensive Care 
      Medicine at the University Hospital Innsbruck. We retrospectively included all 
      patients between 2008 and 2012, who received argatroban because of poor response 
      to high-dosage heparin prophylaxis. The period under observation lasted in total 
      for 9 days, 2 days of anticoagulation with unfractionated heparin (UFH) and 7 
      days with argatroban. The primary objective was to investigate if after 7 (+/- 1) 
      hours of switching to argatroban the activated partial thromboplastin time (aPTT) 
      levels were in a prophylactic range of 45 to 55 seconds. Further objectives were 
      to assess the AT level, side effects such as bleeding or thromboembolism, 
      platelet count, correlation between organ function and argatroban dose as well as 
      any need for allogeneic blood products. The study population, consisting of 5 
      women and 15 men with a mean (+/- standard deviation, SD) age of 54.6 +/- 16.3 years, 
      differed in many clinical aspects. A median (interquartile range) heparin dose of 
      1,000, 819 to 1,125 IU/h was administered for 2 days and failed in providing a 
      prophylactic anticoagulation measured by the aPTT. The mean aPTT level with 
      heparin treatment was 38.5 seconds (+/- 4.7) its change within that period was not 
      significant. After switching to argatroban, the mean increase of the aPTT levels 
      in all study patients amounted from 38.5 to 48.3 seconds (p < 0.001). The rise in 
      aPTT clearly reaches sufficient prophylactic anticoagulant levels. The 
      maintenance of prophylactic aPTT levels was achieved over the period of 1 week. 
      There was neither a correlation found between low-AT levels and occurrence of 
      heparin resistance, nor between the simplified acute physiology score II and the 
      administered argatroban dose (r = -0.224, p = 0.342). The results of the present 
      study indicate that argatroban is an effective alternative therapy, especially in 
      critically ill patients, to achieve prophylactic anticoagulation when heparin 
      resistance occurs.
CI  - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
FAU - Treichl, Benjamin
AU  - Treichl B
AD  - Department of Anesthesia and Intensive Care Medicine, Medical University 
      Innsbruck, Austria.
FAU - Bachler, Mirjam
AU  - Bachler M
AD  - Department of General and Surgical Intensive Care Medicine, Medical University 
      Innsbruck, Innsbruck, Austria.
FAU - Lorenz, Ingo
AU  - Lorenz I
AD  - Department of General and Surgical Intensive Care Medicine, Medical University 
      Innsbruck, Innsbruck, Austria.
FAU - Friesenecker, Barbara
AU  - Friesenecker B
AD  - Department of General and Surgical Intensive Care Medicine, Medical University 
      Innsbruck, Innsbruck, Austria.
FAU - Oswald, Elgar
AU  - Oswald E
AD  - Department of Anesthesia and Intensive Care Medicine, Medical University 
      Innsbruck, Austria.
FAU - Schlimp, Christoph J
AU  - Schlimp CJ
AD  - Ludwig Boltzmann Institute, For Experimental and Clinical Traumatology, AUVA 
      Research Centre, Vienna, Austria.
FAU - Pedross, Florian
AU  - Pedross F
AD  - Department of Medical Statistics, Informatics and Health Economics, Medical 
      University Innsbruck, Innsbruck, Austria.
FAU - Fries, Dietmar
AU  - Fries D
AD  - Department of General and Surgical Intensive Care Medicine, Medical University 
      Innsbruck, Innsbruck, Austria.
LA  - eng
PT  - Journal Article
DEP - 20150116
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 0 (Anticoagulants)
RN  - 0 (Pipecolic Acids)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Sulfonamides)
RN  - 9000-94-6 (Antithrombin III)
RN  - 9005-49-6 (Heparin)
RN  - 94ZLA3W45F (Arginine)
RN  - IY90U61Z3S (argatroban)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Antithrombin III/metabolism
MH  - Arginine/analogs & derivatives
MH  - *Critical Illness
MH  - Drug Resistance
MH  - Female
MH  - Heparin/pharmacology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pipecolic Acids/*therapeutic use
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Retrospective Studies
MH  - Sulfonamides
EDAT- 2015/01/17 06:00
MHDA- 2015/10/21 06:00
CRDT- 2015/01/17 06:00
PHST- 2015/01/17 06:00 [entrez]
PHST- 2015/01/17 06:00 [pubmed]
PHST- 2015/10/21 06:00 [medline]
AID - 10.1055/s-0034-1398382 [doi]
PST - ppublish
SO  - Semin Thromb Hemost. 2015 Feb;41(1):61-7. doi: 10.1055/s-0034-1398382. Epub 2015 
      Jan 16.