Journal article
Argatroban Anticoagulant Therapy in Patients With Heparin-Induced Thrombocytopenia
Circulation (New York, N.Y.), Vol.103(14), pp.1838-1843
04/10/2001
DOI: 10.1161/01.CIR.103.14.1838
PMID: 11294800
Abstract
Background
—Heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome caused by heparin. Complications range from thrombocytopenia to thrombocytopenia with thrombosis. We report a prospective, historical- controlled study evaluating the efficacy and safety of argatroban, a direct thrombin inhibitor, as anticoagulant therapy in patients with HIT or HIT with thrombosis syndrome (HITTS).
Methods and Results
—Patients with HIT (isolated thrombocytopenia, n=160) or HITTS (n=144) received 2 μg · kg
−1
· min
−1
IV argatroban, adjusted to maintain the activated partial thromboplastin time 1.5 to 3.0 times baseline value. Treatment was maintained for 6 days, on average. Clinical outcomes over 37 days were compared with those of 193 historical control subjects with HIT (n=147) or HITTS (n=46). The incidence of the primary efficacy end point, a composite of all-cause death, all-cause amputation, or new thrombosis, was reduced significantly in argatroban-treated patients versus control subjects with HIT (25.6% versus 38.8%,
P
=0.014). In HITTS, the composite incidence in argatroban-treated patients was 43.8% versus 56.5% in control subjects (
P
=0.13). Significant between-group differences by time-to-event analysis of the composite end point favored argatroban treatment in HIT (
P
=0.010) and HITTS (
P
=0.014). Argatroban therapy, relative to control subjects, also significantly reduced new thrombosis and death caused by thrombosis (
P
<0.05). Argatroban-treated patients achieved therapeutic activated partial thromboplastin times generally within 4 to 5 hours of starting therapy and, compared with control subjects, had a significantly more rapid rise in platelet counts (
P
=0.0001). Bleeding events were similar between groups.
Conclusions
—Argatroban anticoagulation, compared with historical control subjects, improves clinical outcomes in patients who have heparin-induced thrombocytopenia, without increasing bleeding risk.
Details
- Title: Subtitle
- Argatroban Anticoagulant Therapy in Patients With Heparin-Induced Thrombocytopenia
- Creators
- B. E. Lewis - Loyola University Medical CenterD. E. WallisS. D. BerkowitzW. H. MatthaiJ. FareedJ. M. WalengaJ. BartholomewR. ShamR. G. LernerZ. R. ZeiglerP. K. RustagiI. K. JangS. D. RifkinJ. MoranM. J. HurstingJ. G. Kelton - Lippincott Williams & WilkinsARG-911 Study Investigators
- Contributors
- D Macfarlane (Contributor) - University of Iowa, Hematology, Oncology, and Blood & Marrow Transplantation
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.103(14), pp.1838-1843
- DOI
- 10.1161/01.CIR.103.14.1838
- PMID
- 11294800
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 04/10/2001
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359913802771
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