PMID- 33653194
OWN - NLM
STAT- MEDLINE
DCOM- 20220317
LR  - 20220421
IS  - 1525-1489 (Electronic)
IS  - 0885-0666 (Linking)
VI  - 37
IP  - 4
DP  - 2022 Apr
TI  - Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A 
      Systematic Review.
PG  - 459-471
LID - 10.1177/0885066621993739 [doi]
AB  - BACKGROUND: Heparin is the widely used anti-coagulation strategy for patients on 
      extracorporeal membrane oxygenation (ECMO). Nevertheless, heparin-induced 
      thrombocytopenia (HIT) and acquired anti-thrombin (AT) deficiency preclude the 
      use of heparin requiring utilization of an alternative anticoagulant agent. 
      Direct thrombin inhibitors are being proposed as potential alternatives with 
      argatroban as one of the main agents. We aimed to review the evidence with regard 
      to safety and efficacy of argatroban as a potential definitive alternative to 
      heparin in the adult patient population undergoing ECMO support. METHODS: A 
      web-based systematic literature search was performed in Medline (PubMed) and 
      Embase from inception until June 18, 2020. RESULTS: The search identified 13 
      publications relevant to the target (4 cohort studies and 9 case series). Case 
      reports and case series with less than 3 cases were not included in the 
      qualitative synthesis. The aggregate number of argatroban treated patients on 
      ECMO was n = 307. In the majority of studies argatroban was used as a continuous 
      infusion without loading dose. Starting doses on ECMO varied between 0.05 and 2 
      mug/kg/min and were titrated to achieve the chosen therapeutic target range. The 
      activated partial thormboplastin time (aPTT) was the anticoagulation parameter 
      used for monitoring purposes in most studies, whereas some utilized the activated 
      clotting time (ACT). Optimal therapeutic targets varied between 43-70 and 60-100 
      seconds for aPTT and between 150-210 and 180-230 seconds for ACT. Bleeding and 
      thromboembolic complication rates were comparable to patients treated with 
      unfractionated heparin (UFH). CONCLUSIONS: Argatroban infusion rates and 
      anticoagulation target ranges showed substantial variations. The rational for 
      divergent dosing and monitoring approaches are discussed in this paper. 
      Argatroban appears to be a potential alternative to UFH in patients requiring 
      ECMO. To definitively establish its safety, efficacy and ideal dosing strategy, 
      larger prospective studies on well-defined patient populations are warranted.
FAU - Geli, Janos
AU  - Geli J
AUID- ORCID: 0000-0002-0432-3128
AD  - Department of Cardiothoracic Anaesthesia and Critical Care, 59562Karolinska 
      University Hospital, Stockholm, Sweden.
FAU - Capoccia, Massimo
AU  - Capoccia M
AUID- ORCID: 0000-0002-2351-9994
AD  - Department of Aortic and Cardiac Surgery, 156726Royal Brompton Hospital, Royal 
      Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
FAU - Maybauer, Dirk M
AU  - Maybauer DM
AD  - Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 
      Marburg, Germany.
FAU - Maybauer, Marc O
AU  - Maybauer MO
AD  - Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 
      Marburg, Germany.
AD  - Department of Anaesthesia, 105551Manchester Royal Infirmary, Manchester 
      University NHS Foundation Trust, The University of Manchester and Manchester 
      Academic Health Science Centre, Manchester, United Kingdom.
AD  - Critical Care Research Group, The Prince Charles Hospital and The University of 
      Queensland, Brisbane, Queensland, Australia.
AD  - Nazih Zuhdi Transplant Institute, Advanced Critical Care, Integris Baptist 
      Medical Centre, Oklahoma City, and Oklahoma State University, Tulsa, Oklahoma, 
      USA.
LA  - eng
PT  - Journal Article
PT  - Systematic Review
DEP - 20210303
PL  - United States
TA  - J Intensive Care Med
JT  - Journal of intensive care medicine
JID - 8610344
RN  - 0 (Anticoagulants)
RN  - 0 (Pipecolic Acids)
RN  - 0 (Sulfonamides)
RN  - 9005-49-6 (Heparin)
RN  - 94ZLA3W45F (Arginine)
RN  - IY90U61Z3S (argatroban)
SB  - IM
MH  - Adult
MH  - Anticoagulants
MH  - Arginine/analogs & derivatives
MH  - *Extracorporeal Membrane Oxygenation
MH  - Heparin/adverse effects
MH  - Humans
MH  - Pipecolic Acids
MH  - Prospective Studies
MH  - Sulfonamides
OTO - NOTNLM
OT  - DTI
OT  - ECMO
OT  - direct thrombin inhibitor
OT  - extra-corporeal life support
OT  - heparin
EDAT- 2021/03/04 06:00
MHDA- 2022/03/18 06:00
CRDT- 2021/03/03 05:32
PHST- 2021/03/04 06:00 [pubmed]
PHST- 2022/03/18 06:00 [medline]
PHST- 2021/03/03 05:32 [entrez]
AID - 10.1177/0885066621993739 [doi]
PST - ppublish
SO  - J Intensive Care Med. 2022 Apr;37(4):459-471. doi: 10.1177/0885066621993739. Epub 
      2021 Mar 3.