Heparin-induced thrombocytopenia

Section editors
	Shruti Chaturvedi, MBBS, MSCI Baltimore, MD LinkedIn		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 (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

1. 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],
2. 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

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

1. 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.