Heparin-induced thrombocytopenia
| Section editors | |||
|---|---|---|---|
 |
Shruti Chaturvedi, MBBS, MSCI Baltimore, MD |
 |
Benjamin Tillman, MD Nashville, TN |
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Guidelines
To be completed
All lines of therapy
Argatroban monotherapy
Regimen
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Lewis et al. 2001 (ARG-911) | Prospective, historical control | Multiple | Reduced all-cause death, all-cause amputation, and new thrombosis |
| Treschan et al. 2014 | Randomized, double-blind | Lepirudin | Suggests less bleeding in surgical patients with argatroban. |
Anticoagulation
- ARG-911: Argatroban (Acova) 2 mcg/kg/min IV adjusted to maintain activated partial thromboplastin time 1.5 to 3.0 times baseline value.
- ALicia: Argatroban (Acova) without liver dysfunction: 0.5 mcg/kg/min IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
- ALicia: Argatroban (Acova) with severe liver dysfunction (bilirubin >4 mg/dL): 0.25 mcg/kg/min IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
References
- ARG-911: Lewis BE, Wallis DE, Berkowitz SD, Matthai WH, Fareed J, Walenga JM, Bartholomew J, Sham R, Lerner RG, Zeigler ZR, Rustagi PK, Jang IK, Rifkin SD, Moran J, Hursting MJ, Kelton JG; ARG-911 Study Investigators. Argatroban anticoagulant therapy in patients with heparin-induced thrombocytopenia. Circulation. 2001 Apr 10;103(14):1838-43. link to original article. PubMed.anja A Treschan[author],
- ALicia: Treschan TA, Schaefer MS, Geib J, Bahlmann A, Brezina, T, Werner P, Golla, E, Greinacher A, Pannen B, Kindgen-Milles D, Kienbaum P, Beiderlinden M. Argatroban versus Lepirudin in critically ill patients (ALicia): a randomized controlled trial. Critical Care. 2014 Oct 25;18(5):588. link to original article. PubMed.
- Only 15 patients (23%) in the study had confirmed HIT.
Lepirudin monotherapy
| Treschan et al. 2014 | Randomized, double-blind | Argatroban | Suggests less bleeding in surgical patients with argatroban. |
|---|---|---|---|
- ALicia: Treschan TA, Schaefer MS, Geib J, Bahlmann A, Brezina, T, Werner P, Golla, E, Greinacher A, Pannen B, Kindgen-Milles D, Kienbaum P, Beiderlinden M. Argatroban versus Lepirudin in critically ill patients (ALicia): a randomized controlled trial. Critical Care. 2014 Oct 25;18(5):588. link to original article. PubMed.
- Only 15 patients (23%) in the study had confirmed HIT.