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Argatroban anticoagulant therapy in patients with heparin-induced thrombocytopenia.

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 microgram. 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.

journal_name

Circulation

journal_title

Circulation

authors

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.

doi

10.1161/01.cir.103.14.1838

subject

Has Abstract

pub_date

2001-04-10 00:00:00

pages

1838-43

issue

eissn

0009-7322

issn

1524-4539

journal_volume

103

pub_type

临床试验,杂志文章,多中心研究

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Argatroban anticoagulant therapy in patients with heparin-induced thrombocytopenia.