Practical guidelines for Argatroban and Bivalirudin in patients with Heparin-induced Thrombocytopenia.

Détails

ID Serval
serval:BIB_3456191B0275
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Practical guidelines for Argatroban and Bivalirudin in patients with Heparin-induced Thrombocytopenia.
Périodique
J Translational Science
Auteur⸱e⸱s
Colucci G., Nagler M., Klaus N., Conte T., Giabbani E., Alberio L.
ISSN
2059-268X
Statut éditorial
Publié
Date de publication
28/09/2015
Peer-reviewed
Oui
Volume
1
Numéro
2
Pages
37-42
Langue
anglais
Résumé
Argatroban and bivalirudin are two direct thrombin inhibitors (DTI) employed to treat heparin-induced thrombocytopenia (HIT). Following the withdrawal of lepirudin in 2012 we needed to establish in-house therapeutic ranges and dosing schedules for both DTI, since their practical handling was not clearly defined. Here we report our experience on HIT-patients treated with argatroban or bivalirudin between December 2012 and February 2014. We assessed anticoagulation by measuring aPTT, thrombin time (TT, final thrombin concentrations of 1.5 U/l for TT1.5 and 5.0 U/ml for TT5) and plasmatic DTI concentrations. In-house therapeutic target for argaroban was TT1.5 55–100 sec, corresponding to a 1.7–2 fold aPTT prolongation and plasmatic argatroban concentrations of 0.4–0.8 µg/ml. For bivalirudin, in-house target ranged between TT1.5 >110 sec and TT5 <40 sec, corresponding to a 2.5 fold aPTT prolongation and bivalirudin concentrations of about 1.0 µg/ml. We treated 10 HIT-patients (6 with thrombotic HIT, HIT-T) with argatroban, for a total of 159 days of treatment. Four HIT-patients (2 HIT-T) were treated with bivalirudin for a total of 53 days. Median treatment length was 15 days for both DTI. Clinical and laboratory course was favorable in all patients, with rapid normalization of the platelet count and a decrease of the strongly elevated D-dimers. We observed no severe bleedings and one deep vein thrombosis attributable to an insufficient anticoagulation with argatroban. In our experience, monitoring argatroban and bivalirudin with TT permits an efficient anticoagulation of HIT-patients. Treatment targets (either TT or aPTT) have to be established with the local reagent/coagulometer combination. In HIT patients with normal liver (argatroban) or renal (bivalirudin) function, we suggest starting both DTI at a dose of 0.06 mg/kg/h (corresponding to 1.0 µg/kg/min) and to adjust it in steps of 0.015 mg/kg/h (i.e. 0.25 µg/kg/min) for argatroban and 0.05 mg/kg/h for bivalirudin.
Création de la notice
11/10/2015 21:19
Dernière modification de la notice
28/03/2023 5:52
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