Difference between revisions of "Heparin-induced thrombocytopenia"
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|Reduced all-cause death, all-cause amputation, and new thrombosis | |Reduced all-cause death, all-cause amputation, and new thrombosis | ||
|- | |- | ||
| − | |[https://www.ncbi.nlm.nih.gov/pubmed/25344113 Treschan et al. 2014] | + | |[https://www.ncbi.nlm.nih.gov/pubmed/25344113 Treschan et al. 2014 (ALicia)] |
|Randomized, double-blind | |Randomized, double-blind | ||
|Lepirudin | |Lepirudin | ||
|Suggests less bleeding in surgical patients with argatroban. | |Suggests less bleeding in surgical patients with argatroban. | ||
| + | |- | ||
| + | |[https://www.ncbi.nlm.nih.gov/pubmed/25515959 Kang M et al. 2015] | ||
| + | |Retrospective, propensity matched | ||
| + | |Danaparoid, Fondaparinux | ||
| + | | | ||
|} | |} | ||
====Anticoagulation==== | ====Anticoagulation==== | ||
| Line 44: | Line 49: | ||
# '''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. [https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0588-8 link to original article]. [https://www.ncbi.nlm.nih.gov/pubmed/25344113 PubMed.] | # '''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. [https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0588-8 link to original article]. [https://www.ncbi.nlm.nih.gov/pubmed/25344113 PubMed.] | ||
#* Only 15 patients (23%) in the study had confirmed HIT. | #* Only 15 patients (23%) in the study had confirmed HIT. | ||
| + | |||
| + | == Fondaprinux monotherapy == | ||
| + | |||
| + | === Regimen === | ||
== Lepirudin monotherapy == | == Lepirudin monotherapy == | ||
| + | |||
| + | === Regimen === | ||
{| class="wikitable" | {| class="wikitable" | ||
| − | |[https://www.ncbi.nlm.nih.gov/pubmed/25344113 Treschan et al. 2014] | + | !Study |
| − | + | !Evidence | |
| + | !Comparator | ||
| + | !Efficacy | ||
| + | |- | ||
| + | |[https://www.ncbi.nlm.nih.gov/pubmed/25344113 Treschan et al. 2014 (ALicia)] | ||
| + | |Randomized, double-blind | ||
|Argatroban | |Argatroban | ||
|Suggests less bleeding in surgical patients with argatroban. | |Suggests less bleeding in surgical patients with argatroban. | ||
| Line 67: | Line 83: | ||
| | | | ||
|} | |} | ||
| + | |||
| + | ==== Anticoagulation ==== | ||
| + | * '''ALicia:''' Lepirudin paitents with continuous renal replacement therapy: 5 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value. | ||
| + | * '''ALicia:''' Lepirudin paitents with moderate renal impairment (creatinine >=1.3 mg/dl): 10 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value. | ||
| + | * '''ALicia:''' Lepirudin paitents with without renal impairment (creatinine <1.3 mg/dl): 50 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value. | ||
| + | |||
| + | === References === | ||
# '''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. [https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0588-8 link to original article]. [https://www.ncbi.nlm.nih.gov/pubmed/25344113 PubMed.] | # '''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. [https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0588-8 link to original article]. [https://www.ncbi.nlm.nih.gov/pubmed/25344113 PubMed.] | ||
#* Only 15 patients (23%) in the study had confirmed HIT. | #* Only 15 patients (23%) in the study had confirmed HIT. | ||
Revision as of 02:28, 10 September 2018
| Section editors | |||
|---|---|---|---|
 |
Shruti Chaturvedi, MBBS, MSCI Baltimore, MD |
 |
Benjamin Tillman, MD Nashville, TN |
0 regimens on this page
0 variants on this page
|
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 (ALicia) | Randomized, double-blind | Lepirudin | Suggests less bleeding in surgical patients with argatroban. |
| Kang M et al. 2015 | Retrospective, propensity matched | Danaparoid, Fondaparinux |
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.
Fondaprinux monotherapy
Regimen
Lepirudin monotherapy
Regimen
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Treschan et al. 2014 (ALicia) | Randomized, double-blind | Argatroban | Suggests less bleeding in surgical patients with argatroban. |
Anticoagulation
- ALicia: Lepirudin paitents with continuous renal replacement therapy: 5 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
- ALicia: Lepirudin paitents with moderate renal impairment (creatinine >=1.3 mg/dl): 10 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
- ALicia: Lepirudin paitents with without renal impairment (creatinine <1.3 mg/dl): 50 mcg/kg/hr IV adjusted to maintain activated partial thromboplastin time 1.5 to 2.0 times baseline value.
References
- 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.