PMID- 38452448
OWN - NLM
STAT- MEDLINE
DCOM- 20240401
LR  - 20240401
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 236
DP  - 2024 Apr
TI  - Anticoagulation with argatroban using hemoclot targets is safe and effective in 
      CARDS patients receiving venovenous extracorporeal membrane oxygenation: An 
      exploratory bi-centric cohort study.
PG  - 161-166
LID - S0049-3848(24)00067-7 [pii]
LID - 10.1016/j.thromres.2024.02.026 [doi]
AB  - Direct thrombin inhibitors, including argatroban, are increasingly used for 
      anticoagulation during venovenous extracorporeal membrane oxygenation (VV ECMO). 
      In many centers activated partial thromboplastin time (aPTT) is used for 
      monitoring, but it can be affected by several confounders. The aim of this study 
      was to evaluate the safety and efficacy of anticoagulation with argatroban 
      titrated according to diluted thrombin time targets (hemoclot assay) compared to 
      anti-Xa guided anticoagulation with unfractionated heparin (UFH). METHODS: This 
      cohort study included adults at two tertiary care centers who required VV ECMO 
      for severe COVID-19-related acute respiratory distress syndrome (CARDS). Patients 
      received center-dependent argatroban or UFH for anticoagulation during ECMO. 
      Argatroban was guided following a hemoclot target range of 0.4-0.6 mug/ml. UFH 
      was guided by anti-factor Xa (antiXa) levels (0.2-0.3 IU/ml). The primary outcome 
      was safety of argatroban compared to UFH, assessed by time to first clinically 
      relevant bleeding event or death during ECMO. Secondary outcomes included 
      efficacy (time to thromboembolism) and feasibility (proportion of anticoagulation 
      targets within range). RESULTS: From 2019 to 2021 57 patients were included in 
      the study with 27 patients (47 %) receiving argatroban and 30 patients (53 %) 
      receiving UFH. The time to the first clinically relevant bleeding or death during 
      ECMO was similar between groups (HR (argatroban vs. UFH): 1.012, 95 % CI 
      0.44-2.35, p = 0.978). Argatroban was associated with a decreased risk for 
      thromboembolism compared to UFH (HR 0.494 (95 % CI 0.26-0.95; p = 0.034)). The 
      overall proportion of anticoagulation within target ranges was not different 
      between groups (46 % (23-54 %) vs. 46 % (37 %-57 %), p = 0.45). CONCLUSION: 
      Anticoagulation with argatroban according to hemoclot targets (0.4-0.6 mug/ml) 
      compared to antiXa guided UFH (0.2-0.3 IU/ml) is safe and may prolong 
      thromboembolism-free time in patients with severe ARDS requiring VV ECMO.
CI  - Copyright (c) 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Mayerhofer, Timo
AU  - Mayerhofer T
AD  - Division of Intensive Care and Emergency Medicine, Department of Internal 
      Medicine, Medical University Innsbruck, Austria.
FAU - Joannidis, Michael
AU  - Joannidis M
AD  - Division of Intensive Care and Emergency Medicine, Department of Internal 
      Medicine, Medical University Innsbruck, Austria.
FAU - Peer, Andreas
AU  - Peer A
AD  - Division of Intensive Care and Emergency Medicine, Department of Internal 
      Medicine, Medical University Innsbruck, Austria.
FAU - Perschinka, Fabian
AU  - Perschinka F
AD  - Division of Intensive Care and Emergency Medicine, Department of Internal 
      Medicine, Medical University Innsbruck, Austria.
FAU - Fries, Dietmar
AU  - Fries D
AD  - Department of Anaesthesiology and Intensive Care Medicine, Medical University 
      Innsbruck, Innsbruck, Austria.
FAU - Mair, Peter
AU  - Mair P
AD  - Department of Anaesthesiology and Intensive Care Medicine, Medical University 
      Innsbruck, Innsbruck, Austria.
FAU - Gasteiger, Lukas
AU  - Gasteiger L
AD  - Department of Anaesthesiology and Intensive Care Medicine, Medical University 
      Innsbruck, Innsbruck, Austria.
FAU - Bachler, Mirjam
AU  - Bachler M
AD  - Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT - 
      Private University for Health Sciences and Health Technology, Hall i.T., Austria.
FAU - Kilo, Juliane
AU  - Kilo J
AD  - Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
FAU - Herkner, Harald
AU  - Herkner H
AD  - Department of Emergency Medicine, Medical University of Vienna, Austria.
FAU - Schwameis, Michael
AU  - Schwameis M
AD  - Department of Emergency Medicine, Medical University of Vienna, Austria.
FAU - Schellongowski, Peter
AU  - Schellongowski P
AD  - Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 
      Austria.
FAU - Nagler, Bernhard
AU  - Nagler B
AD  - Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 
      Austria.
FAU - Kornfehl, Andrea
AU  - Kornfehl A
AD  - Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 
      Austria.
FAU - Staudinger, Thomas
AU  - Staudinger T
AD  - Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 
      Austria.
FAU - Buchtele, Nina
AU  - Buchtele N
AD  - Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, 
      Austria. Electronic address: nina.buchtele@meduniwien.ac.at.
LA  - eng
PT  - Journal Article
DEP - 20240302
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
RN  - IY90U61Z3S (argatroban)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 94ZLA3W45F (Arginine)
RN  - 0 (Pipecolic Acids)
RN  - 0 (Sulfonamides)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Heparin/therapeutic use/pharmacology
MH  - Anticoagulants/therapeutic use
MH  - *Extracorporeal Membrane Oxygenation
MH  - Cohort Studies
MH  - Heparin, Low-Molecular-Weight
MH  - Hemorrhage
MH  - *Thromboembolism
MH  - *Respiratory Distress Syndrome/drug therapy
MH  - Retrospective Studies
MH  - Arginine/*analogs & derivatives
MH  - *Pipecolic Acids
MH  - *Sulfonamides
OTO - NOTNLM
OT  - COVID-19
OT  - Critically ill
OT  - Direct thrombin inhibitor
OT  - Intensive care unit
OT  - SARS-CoV2
COIS- Declaration of competing interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2024/03/08 00:43
MHDA- 2024/04/01 06:42
CRDT- 2024/03/07 18:03
PHST- 2023/12/13 00:00 [received]
PHST- 2024/02/19 00:00 [revised]
PHST- 2024/02/24 00:00 [accepted]
PHST- 2024/04/01 06:42 [medline]
PHST- 2024/03/08 00:43 [pubmed]
PHST- 2024/03/07 18:03 [entrez]
AID - S0049-3848(24)00067-7 [pii]
AID - 10.1016/j.thromres.2024.02.026 [doi]
PST - ppublish
SO  - Thromb Res. 2024 Apr;236:161-166. doi: 10.1016/j.thromres.2024.02.026. Epub 2024 
      Mar 2.