Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices

F. Pappalardo, A. M. Scandroglio, E. Potapov, A. Stepanenko, G. Maj, T. Krabatsch, A. Zangrillo, A. Koster, R. Hetzer

Research output: Contribution to journalArticle

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Abstract

Background. Patients receiving implantation of ventricular assist devices (VAD) suffer a high incidence of heparin induced thrombocytopenia (HIT); the occurrence of this condition is associated with increased complications and worse outcomes. We report our experience in the management of patients who were diagnosed with HIT either before (HITpre) or after (HITpost) implantation of VAD with argatroban, a direct thrombin inhibitor. Methods. This retrospective analysis assessed data of VAD patients diagnosed with HIT at Deutsches Herzzentrum Berlin between November 2005 and April 2009. Argatroban dose requirements, anticoagulation efficacy and adverse events (death, thromboembolism, bleeding) were recorded. Procedural success (discharge from the hospital, heart transplantation, or recovery of the failing heart) was also assessed. Results. Twenty-seven patients were identified (11 HITpre, 16 HITpost). Argatroban was effective in obtaining adequate anticoagulation with a reduced dose regimen (0.02-0.42 mcg/Kg/min starting dose; 0.02-1.5 mcg/Kg/ min maintenance dose). We noted 5 thromboembolic complications (18%), 6 cases of major bleeding (22%) and 5 deaths (18%), all cause composite adverse end point occurring in 40% of patients. Procedural success was obtained in 81% of patients (92% HITpre, 69% HITpost). As compared to historical controls of patients treated with lepirudin in the period 2000-2005, results were significantly improved. Conclusion. Argatroban anticoagulation is feasible in patients with HIT after VAD implantation, without increasing bleeding risk. Its impact in terms of survival should be reviewed also in the light of the technological improvements of assist devices.

Original languageEnglish
Pages (from-to)330-335
Number of pages6
JournalMinerva Anestesiologica
Volume78
Issue number3
Publication statusPublished - Mar 2012

Fingerprint

Heart-Assist Devices
Thrombocytopenia
Heparin
Hemorrhage
Antithrombins
argatroban
Thromboembolism
Berlin
Heart Transplantation
Equipment and Supplies
Survival
Incidence

Keywords

  • Argatroban
  • Heparin
  • Thrombocytopenia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Pappalardo, F., Scandroglio, A. M., Potapov, E., Stepanenko, A., Maj, G., Krabatsch, T., ... Hetzer, R. (2012). Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices. Minerva Anestesiologica, 78(3), 330-335.

Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices. / Pappalardo, F.; Scandroglio, A. M.; Potapov, E.; Stepanenko, A.; Maj, G.; Krabatsch, T.; Zangrillo, A.; Koster, A.; Hetzer, R.

In: Minerva Anestesiologica, Vol. 78, No. 3, 03.2012, p. 330-335.

Research output: Contribution to journalArticle

Pappalardo, F, Scandroglio, AM, Potapov, E, Stepanenko, A, Maj, G, Krabatsch, T, Zangrillo, A, Koster, A & Hetzer, R 2012, 'Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices', Minerva Anestesiologica, vol. 78, no. 3, pp. 330-335.
Pappalardo F, Scandroglio AM, Potapov E, Stepanenko A, Maj G, Krabatsch T et al. Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices. Minerva Anestesiologica. 2012 Mar;78(3):330-335.
Pappalardo, F. ; Scandroglio, A. M. ; Potapov, E. ; Stepanenko, A. ; Maj, G. ; Krabatsch, T. ; Zangrillo, A. ; Koster, A. ; Hetzer, R. / Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices. In: Minerva Anestesiologica. 2012 ; Vol. 78, No. 3. pp. 330-335.
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abstract = "Background. Patients receiving implantation of ventricular assist devices (VAD) suffer a high incidence of heparin induced thrombocytopenia (HIT); the occurrence of this condition is associated with increased complications and worse outcomes. We report our experience in the management of patients who were diagnosed with HIT either before (HITpre) or after (HITpost) implantation of VAD with argatroban, a direct thrombin inhibitor. Methods. This retrospective analysis assessed data of VAD patients diagnosed with HIT at Deutsches Herzzentrum Berlin between November 2005 and April 2009. Argatroban dose requirements, anticoagulation efficacy and adverse events (death, thromboembolism, bleeding) were recorded. Procedural success (discharge from the hospital, heart transplantation, or recovery of the failing heart) was also assessed. Results. Twenty-seven patients were identified (11 HITpre, 16 HITpost). Argatroban was effective in obtaining adequate anticoagulation with a reduced dose regimen (0.02-0.42 mcg/Kg/min starting dose; 0.02-1.5 mcg/Kg/ min maintenance dose). We noted 5 thromboembolic complications (18{\%}), 6 cases of major bleeding (22{\%}) and 5 deaths (18{\%}), all cause composite adverse end point occurring in 40{\%} of patients. Procedural success was obtained in 81{\%} of patients (92{\%} HITpre, 69{\%} HITpost). As compared to historical controls of patients treated with lepirudin in the period 2000-2005, results were significantly improved. Conclusion. Argatroban anticoagulation is feasible in patients with HIT after VAD implantation, without increasing bleeding risk. Its impact in terms of survival should be reviewed also in the light of the technological improvements of assist devices.",
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T1 - Argatroban anticoagulation for heparin induced thrombocytopenia in patients with ventricular assist devices

AU - Pappalardo, F.

AU - Scandroglio, A. M.

AU - Potapov, E.

AU - Stepanenko, A.

AU - Maj, G.

AU - Krabatsch, T.

AU - Zangrillo, A.

AU - Koster, A.

AU - Hetzer, R.

PY - 2012/3

Y1 - 2012/3

N2 - Background. Patients receiving implantation of ventricular assist devices (VAD) suffer a high incidence of heparin induced thrombocytopenia (HIT); the occurrence of this condition is associated with increased complications and worse outcomes. We report our experience in the management of patients who were diagnosed with HIT either before (HITpre) or after (HITpost) implantation of VAD with argatroban, a direct thrombin inhibitor. Methods. This retrospective analysis assessed data of VAD patients diagnosed with HIT at Deutsches Herzzentrum Berlin between November 2005 and April 2009. Argatroban dose requirements, anticoagulation efficacy and adverse events (death, thromboembolism, bleeding) were recorded. Procedural success (discharge from the hospital, heart transplantation, or recovery of the failing heart) was also assessed. Results. Twenty-seven patients were identified (11 HITpre, 16 HITpost). Argatroban was effective in obtaining adequate anticoagulation with a reduced dose regimen (0.02-0.42 mcg/Kg/min starting dose; 0.02-1.5 mcg/Kg/ min maintenance dose). We noted 5 thromboembolic complications (18%), 6 cases of major bleeding (22%) and 5 deaths (18%), all cause composite adverse end point occurring in 40% of patients. Procedural success was obtained in 81% of patients (92% HITpre, 69% HITpost). As compared to historical controls of patients treated with lepirudin in the period 2000-2005, results were significantly improved. Conclusion. Argatroban anticoagulation is feasible in patients with HIT after VAD implantation, without increasing bleeding risk. Its impact in terms of survival should be reviewed also in the light of the technological improvements of assist devices.

AB - Background. Patients receiving implantation of ventricular assist devices (VAD) suffer a high incidence of heparin induced thrombocytopenia (HIT); the occurrence of this condition is associated with increased complications and worse outcomes. We report our experience in the management of patients who were diagnosed with HIT either before (HITpre) or after (HITpost) implantation of VAD with argatroban, a direct thrombin inhibitor. Methods. This retrospective analysis assessed data of VAD patients diagnosed with HIT at Deutsches Herzzentrum Berlin between November 2005 and April 2009. Argatroban dose requirements, anticoagulation efficacy and adverse events (death, thromboembolism, bleeding) were recorded. Procedural success (discharge from the hospital, heart transplantation, or recovery of the failing heart) was also assessed. Results. Twenty-seven patients were identified (11 HITpre, 16 HITpost). Argatroban was effective in obtaining adequate anticoagulation with a reduced dose regimen (0.02-0.42 mcg/Kg/min starting dose; 0.02-1.5 mcg/Kg/ min maintenance dose). We noted 5 thromboembolic complications (18%), 6 cases of major bleeding (22%) and 5 deaths (18%), all cause composite adverse end point occurring in 40% of patients. Procedural success was obtained in 81% of patients (92% HITpre, 69% HITpost). As compared to historical controls of patients treated with lepirudin in the period 2000-2005, results were significantly improved. Conclusion. Argatroban anticoagulation is feasible in patients with HIT after VAD implantation, without increasing bleeding risk. Its impact in terms of survival should be reviewed also in the light of the technological improvements of assist devices.

KW - Argatroban

KW - Heparin

KW - Thrombocytopenia

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