[Anticoagulation in critical care]

Anticoagulation is used in intensive care medicine to prevent and treat thromboembolism. The increased risk of bleeding in this patient population requires a personalized approach to management including individualized anticoagulant selection and dose adjustment. While low-molecular-weight heparins are equivalent or superior to unfractionated heparin for thromboprophylaxis, unfractionated heparin is the preferred therapy for the treatment of thromboembolism. Its advantages include a relatively short half-life, the ability to monitor therapy using the activated partial thromboplastin time and the possibility of rapid and effective reversal. The direct thrombin inhibitor argatroban is a reserve anticoagulant used to treat patients with heparin-induced thrombocytopenia. The advantages of argatroban are its short half-life, hepatic clearance, and the ability to monitor therapeutic levels using the activated partial thromboplastin time.