Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective study
Research article published in Critical care (London, England) (2010)
Abstract
INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is a serious, prothrombotic, immune-mediated adverse reaction triggered by heparin therapy. When HIT is diagnosed or suspected, heparins should be discontinued, and an alternative, fast-acting, parenteral, nonheparin anticoagulation such as argatroban should be initiated. Limited and inconsistent data exist about dosing of argatroban in intensive care unit (ICU) patients with critical illnesses. METHODS: Retrospective analysis of 12 ICU patients with multiple organ dysfunction syndrome (MODS) treated with argatroban for suspected or diagnosed HIT. RESULTS: The 12 ICU patients with a mean platelet count of 46,000 +/- 30,310 had a mean APACHE II score of 26.7 +/- 7.8 on ICU admission and a mean SAPS II score of 61.5 +/- 16.3 on the first day of argatroban administration. A mean argatroban starting dose of 0.32 +/- 0.25 microg/kg/min (min, 0.04; max, 0.83) was used to achieve activated partial thromboplastin times (aPTTs) >60 sec or aPTTs of 1.5 to 3 times the baseline aPTT. Adjustment to aPTT required dose reduction in six (50%) patients. Patients were treated for a mean of 5.5 +/- 3.3 days. The final mean dose in these critically ill patients was 0.24 +/- 0.16 microg/kg/min, which is about one eighth of the usually recommended dose and even markedly lower than the previously suggested dose for critically ill ICU patients. In all patients, desired levels of anticoagulation were achieved. The mean argatroban dose was significantly lower in patients with hepatic insufficiency compared with patients without hepatic impairment (0.10 +/- 0.06 microg/kg/min versus 0.31 +/- 0.14 microg/kg/min; P = 0.026). The mean argatroban dose was significantly correlated with serum bilirubin (r = -0.739; P = 0.006). CONCLUSIONS: ICU Patients with MODS and HIT can be effectively treated with argatroban. A decrease in the initial dosage is mandatory in this patient population. Further studies are needed to investigate argatroban elimination and dosage adjustments for critically ill patients.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Heparin-induced thrombocytopenia (HIT) is a serious, prothrombotic, immune-mediated adverse reaction triggered by heparin therapy.
Por qué esto importa para la hirudoterapia
This retrospective analysis examined dosing requirements for argatroban, described in the abstract as a nonheparin anticoagulant, in 12 intensive care unit patients with multiple organ dysfunction syndrome who had suspected or diagnosed heparin-induced thrombocytopenia (HIT). The study found that critically ill patients required significantly lower argatroban doses than typically recommended, with a mean final dose approximately one-eighth of the usual recommendation, and that hepatic impairment and serum bilirubin levels were significantly correlated with dose requirements. While the study addresses alternative anticoagulation when heparin must be discontinued, the abstract provides no data on hirudotherapy, leeches, hirudin, or the leech secretome. Therefore, this article has no apparent direct relevance to the American Society of Hirudotherapy's domain.
Citación
Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective study
Saugel B et al. · Critical care (London, England), 2010
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026