Argatroban therapy for antithrombin deficiency and mesenteric thrombosis: case report and review of the literature.

Abstract:

:Antithrombin deficiency is a hypercoagulable state that can increase the risk for thrombosis, especially in the presence of other procoagulant triggers. Unfractionated heparin and low-molecular-weight heparins may not provide effective anticoagulation since they require antithrombin for activity. Direct thrombin inhibitors, however, work independently of antithrombin. A 21-year-old man with a history of heavy alcohol consumption had thrombosis of the superior mesenteric vein. Infusion with unfractionated heparin was started, and despite repeated boluses and increases to 21 U/kg/hour, the maximum activated partial thromboplastin time reached was 39 seconds. The unfractionated heparin was discontinued, and the direct thrombin inhibitor argatroban was infused at rates of 0.4-0.5 microg/kg/minute. Over the course of several weeks, the patient had numerous operations to remove and repair necrotic bowel. When no further surgery was anticipated, warfarin therapy was started; the argatroban infusion was discontinued when the patient reached the therapeutic target international normalized ratio with warfarin. No recurrent thrombosis or major bleeding occurred. Direct thrombin inhibitors, such as argatroban, seem to be suitable alternatives for acute anticoagulation in patients with antithrombin deficiency.

journal_name

Pharmacotherapy

journal_title

Pharmacotherapy

authors

Dager WE,Gosselin RC,Owings JT

doi

10.1592/phco.24.6.659.34745

subject

Has Abstract

pub_date

2004-05-01 00:00:00

pages

659-63

issue

5

eissn

0277-0008

issn

1875-9114

journal_volume

24

pub_type

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