Difference between revisions of "Heparin-induced thrombocytopenia"
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|Multiple | |Multiple | ||
|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] | ||
| + | |Randomized, double-blind | ||
| + | |Lepirudin | ||
| + | |Suggests less bleeding in surgical patients with argatroban. | ||
|} | |} | ||
====Anticoagulation==== | ====Anticoagulation==== | ||
| − | *[[Argatroban (Acova)]] 2 mcg/kg/min IV adjusted to maintain activated partial thromboplastin time 1.5 to 3.0 times baseline value. | + | *'''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=== | ===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. [https://www.ahajournals.org/doi/abs/10.1161/circ.103.14.1838 link to original article.] [https://www.ncbi.nlm.nih.gov/pubmed/11294800 PubMed.] | + | # '''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. [https://www.ahajournals.org/doi/abs/10.1161/circ.103.14.1838 link to original article.] [https://www.ncbi.nlm.nih.gov/pubmed/11294800 PubMed.]anja A Treschan[[Mailto:[email protected]|Email 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. [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. | ||
| + | == Lepirudin monotherapy == | ||
| + | {| class="wikitable" | ||
| + | |[https://www.ncbi.nlm.nih.gov/pubmed/25344113 Treschan et al. 2014] | ||
| + | !Randomized, double-blind | ||
| + | |Argatroban | ||
| + | |Suggests less bleeding in surgical patients with argatroban. | ||
| + | |- | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | |- | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | |- | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | |} | ||
| + | # '''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. | ||
[[Category:Heparin-induced thrombocytopenia (HIT) regimens]] | [[Category:Heparin-induced thrombocytopenia (HIT) regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Autoimmune hematologic conditions]] | [[Category:Autoimmune hematologic conditions]] | ||
[[Category:Thrombotic disorders]] | [[Category:Thrombotic disorders]] | ||
Revision as of 02:13, 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
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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 | Randomized, double-blind | Lepirudin | Suggests less bleeding in surgical patients with argatroban. |
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.
Lepirudin monotherapy
| Treschan et al. 2014 | Randomized, double-blind | Argatroban | Suggests less bleeding in surgical patients with argatroban. |
|---|---|---|---|
- 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.