Clinical Experience with Argatroban for Heparin-Induced Thrombocytopenia in a Large Teaching Hospital
Bibliographic record
Abstract
Background: Argatroban is a direct thrombin inhibitor approved for the prophylaxis or treatment of thrombosis in patients with heparininduced thrombocytopenia (HIT). The product monograph does not guide clinicians beyond specifying the initial dose of 2 μg/kg per minute (or 0.5 μg/kg per minute for patients with hepatic impairment). Some authors have suggested that in the intensive care unit (ICU) and for patients with acute cardiac disease and those with renal or hepatic dysfunction, this dose may result in a supratherapeutic activated partial thromboplastin time (aPTT).Objectives: To evaluate the efficacy and safety of argatroban in adult patients with suspected HIT in a large teaching hospital, and to review dosing for patients in the ICU, patients with acute cardiac disease, and patients with renal or hepatic dysfunction.Methods: Charts of patients with suspected HIT who had received argatroban for at least 24 h between October 1, 2005, and October 1, 2007, at the Foothills Medical Centre, Calgary, Alberta, were examined retrospectively.Results: Thirty patients met the inclusion criteria, with charts available for review. Of these, 21 (70%) patients had an initial argatroban dose of 2 μg/kg per minute and 4 (13%) had an initial dose of 0.5 μg/kg per minute. The median duration of therapy was 6 days, and the mean dose was 2.14 μg/kg per minute. There were 122 dosage adjustments, the most common change being 0.5 μg/kg per minute, followed by adjustments of 1 and 0.1 μg/kg per minute. Six patients had supratherapeutic aPTT values (above 100 s), and none experienced major bleeding.Conclusions: The results of this study suggest that an initial argatroban dose of 2 μg/kg per minute is appropriate for patients with no hepatic dysfunction. Patients with acute cardiac disease and critically ill patients may require lower doses of argatroban; however no dosage adjustments are required for patients with renal dysfunction.RÉSUMÉ Contexte : L’argatroban est un inhibiteur direct de la thrombine approuvé pour le traitement ou la prophylaxie de la thrombose chez les patients atteints de thrombocytopénie causée par l’héparine (TCH). La monographie du produit ne donne aux cliniciens aucune autre indication que la dose initiale de 2 μg/kg par minute (ou 0,5 μg/kg par minute chez les patients atteints d’insuffisance hépatique). Certains auteurs ont avancé que chez les patients à l’unité de soins intensifs (USI) et chez les patients atteints d’une cardiopathie aiguë ou d’une insuffisance rénale ou hépatique, cette dose pourrait résulter en un temps partiel de thromboplastine activée (aPTT) suprathérapeutique.Objectifs : Évaluer l’efficacité et l’innocuité de l’argatroban dans le traitement d’une TCH soupçonnée chez les patients adultes d’un important hôpital d’enseignement, et examiner la posologie chez les patients de l’USI, ceux atteints d’une cardiopathie aiguë et ceux souffrant d’insuffisance rénale ou hépatique.Méthodes : Les dossiers médicaux des patients chez qui l’on soupçonnait une TCH et qui ont reçu l’argatroban durant au moins 24 h entre le 1er octobre 2005 et le 1er octobre 2007 au Foothills Medical Centre de Calgary, en Alberta, ont été examinés rétrospectivement.Résultats : Trente patients ont satisfait aux critères d’admissibilité; leurs dossiers médicaux étaient disponibles pour examen. De ces patients, 21 (70 %) ont reçu une dose initiale d’argatroban de 2 μg/kg par minute et 4 (13 %) ont reçu une dose initiale de 0,5 μg/kg par minute. La durée médiane du traitement était de 6 jours, et la dose moyenne, de 2,14 μg/kg par minute. On a recensé 122 ajustements de la dose, la variation la plus courante étant de 0,5 μg/kg par minute, suivie de variations de 1 et de 0,1 μg/kg par minute. Six patients ont obtenu des valeurs d’aPTT suprathérapeutiques (au-dessus de 100 s), et aucun n’a eu de saignement majeur.Conclusions : Les résultats de cette étude suggèrent qu’une dose initiale d’argatroban de 2 μg/kg par minute est appropriée chez les patients ne présentant pas d’insuffisance hépatique. Une dose plus faible d’argatroban pourrait être requise chez les patients atteints d’une cardiopathie aiguë et ceux en phase critique, mais aucun ajustement de la dose n’est requis chez les patients atteints d’insuffisance rénale.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".