Use of argatroban during percutaneous coronary interventions in patients with heparin-induced thrombocytopenia

Percutaneous coronary revascularization (PTCR) procedures require intense anticoagulation during the procedure to reduce the risk of a thrombotic complication. This anticoagulation is almost always performed with unfractionated heparin. Heparin, however, is far from the ideal anticoagulant for use in PTCR, and its use is contraindicated in patients with known or suspected heparin-induced thrombocytopenia (HIT) or the heparin-induced thrombocytopenia and thrombosis syndrome (HITTS). The incidence of HIT/HITTS in the population undergoing PTCR may be increased due to the widespread use of heparin in cardiovascular patients. Direct thrombin inhibitors such as argatroban do not interact with the antibody that causes HIT/HITTS, and so these agents can be used to provide anticoagulation in patients with this dangerous condition. Argatroban was used in a trial of 50 patients with known or suspected HIT or HITTS who required PTCR. Adequate anticoagulation was achieved in 98% and there was procedural success in 98% with only 1 major bleeding event. These preliminary data suggest that argatroban can be used safely and effectively as an anticoagulant during PTCR in patients with known or suspected HIT or HITTS.