Extensive prolongation of aPTT with argatroban in an elderly patient with improving renal function, normal hepatic enzymes, and metastatic lung cancer
Case report published in Annals of Pharmacotherapy (2005)
Abstract
OBJECTIVE: To report a case of an elderly male with improving renal function and normal hepatic function who sustained an elevated activated partial thromboplastin time (aPTT) after an infusion of argatroban was discontinued. CASE SUMMARY: A 77-year-old white male with a history of heparin-induced thrombocytopenia (HIT) and metastatic lung disease was started on argatroban for treatment of a right upper-extremity deep vein thrombosis (DVT). The infusion was initiated at 2.0 microg/kg/min and was titrated to a goal aPTT of 60-80 seconds. Argatroban was discontinued due to an aPTT elevated to >100 seconds; the aPTT remained elevated for 130 hours after discontinuation of the infusion. DISCUSSION: Argatroban dose reductions in patients with impaired liver and renal function test values have been reported. Elderly subjects may have a prolonged clearance compared with young healthy subjects, although the duration of effect has not been established. As of April 18, 2005, the effect of liver metastasis on argatroban pharmacokinetics in the setting of normal liver function enzyme levels has not been reported. An objective causality assessment using the Naranjo probability scale showed that the prolonged aPTT was probably attributable to argatroban. CONCLUSIONS: Clinicians should exercise caution when initiating argatroban at a dose of 2.0 microg/kg/min in elderly patients with underlying comorbidities, such as metastatic disease and renal impairment, since this may lead to excessive and prolonged anticoagulation and increased risk of bleeding.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Case of 77-year-old male with HIT and metastatic lung cancer whose aPTT remained elevated >100 seconds for 130 hours after argatroban discontinuation, suggesting age, comorbidities, and hepatic metastasis can prolong clearance.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe a un hombre de 77 años con antecedentes de trombocitopenia inducida por heparina y enfermedad pulmonar metastásica que inició argatrobán para una trombosis venosa profunda de la extremidad superior derecha. Tras titular la infusión y luego suspenderla por un aPTT superior a 100 segundos, el aPTT permaneció elevado durante 130 horas a pesar de la mejoría de la función renal y enzimas hepáticas normales, con el efecto prolongado atribuido probablemente al argatrobán mediante la evaluación de causalidad de Naranjo. El reporte advierte a los clínicos sobre iniciar argatrobán a 2.0 microgramos/kg/min en pacientes ancianos con comorbilidades como enfermedad metastásica e insuficiencia renal. El resumen no menciona hirudina, sanguijuelas, terapia con sanguijuelas ni el secretoma de la sanguijuela, por lo que no se establece ninguna conexión con la hirudoterapia. La evidencia se limita a un único reporte de caso.
Citación
Extensive prolongation of aPTT with argatroban in an elderly patient with improving renal function, normal hepatic enzymes, and metastatic lung cancer.
Kubiak DW et al. · Annals of Pharmacotherapy, 2005
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026