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Thrombocytopenia following heparin flush
Iris McNulty1, Eliezer Katz, Karissa Y Kim
1Massachusetts General Hospital Bulfinch 001, 55 Fruit Street, Boston, MA 02114, USA. imcnulty@partners.org
Progress in Cardiovascular Nursing
|November 9, 2005
Summary
Argatroban effectively treats heparin-induced thrombocytopenia (HIT) after minimal heparin exposure, including flushes. This study shows argatroban therapy leads to platelet recovery and comparable outcomes to historical controls without direct thrombin inhibitors.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin exposure.
- HIT can occur even with minimal heparin use, such as for catheter flushes.
- Alternative anticoagulation is crucial for patients with HIT.
Purpose of the Study:
- To evaluate the efficacy and safety of argatroban in patients with HIT.
- To compare argatroban therapy outcomes with historical controls who did not receive direct thrombin inhibitors.
Main Methods:
- Prospective study of 23 patients with HIT following heparin exposure.
- 13 patients received argatroban therapy (1.8±1.1 mg/kg/min for 5.5±3.9 days).
- 10 historical control patients received no direct thrombin inhibitors.
Main Results:
- Platelet count recovered to 207±153 x 10(9)/L in the argatroban group versus 127±63 x 10(9)/L in controls.
- Composite endpoint of death, amputation, or new thrombosis within 37 days was 38.5% for argatroban and 40% for controls.
- No new thrombosis occurred in argatroban-treated patients, compared to 20% in controls. Major bleeding was comparable.
Conclusions:
- Argatroban is an effective alternative anticoagulation for HIT, even after minimal heparin exposure.
- Argatroban facilitates platelet count recovery and reduces the risk of new thrombosis.
- Outcomes with argatroban are comparable to historical controls, with a favorable safety profile.