| Recognition of heparin-induced thrombocytopenia and initiation of argatroban therapy after cardiothoracic surgery in the intensive care unit. | |
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MedLine Citation:
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PMID: 22329977 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Patients recovering from cardiothoracic surgery are known to be at increased risk of heparin-induced thrombocytopenia. Postoperatively, if heparin-induced thrombocytopenia is suspected, heparin is discontinued immediately and an alternative anticoagulant, such as the direct thrombin inhibitor argatroban, is administered. Current data regarding the safety and efficacy of argatroban in the postoperative cardiothoracic surgical patient in the intensive care setting are limited. METHODS: Data were collected retrospectively from January 1, 2007, to December 31, 2010, from patients tested for antiplatelet factor 4/heparin antibodies on clinical suspicion of heparin-induced thrombocytopenia after cardiothoracic surgery. We evaluated the use of argatroban as a therapeutic agent for the postoperative treatment of suspected heparin-induced thrombocytopenia by comparing thrombotic and bleeding events, platelet dynamics, antiplatelet factor 4/heparin antibody titer, and clinical probability score between patients who did and did not receive argatroban. RESULTS: Eighty-seven patients were included; 47 patients (54%) were treated with argatroban, and 40 patients (46%) were not treated with argatroban. There was no association between argatroban therapy and bleeding, mortality, length of stay, or pretreatment thrombotic events. Among all patients, antiplatelet factor 4/heparin antibody titer and clinical probability score were higher in patients treated with argatroban. CONCLUSIONS: Clinical suspicion of heparin-induced thrombocytopenia as detected by clinical probability score and thrombotic complications should prompt immediate cessation of heparin and initiation of an alternative anticoagulant such as argatroban. The results from this study demonstrate that argatroban should be considered without increased risk for adverse events, including bleeding, in the cardiothoracic intensive care unit after surgery. |
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Authors:
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Linda J Demma; Christopher A Paciullo; Jerrold H Levy |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2012-02-11 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 143 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-04-16 Completed Date: 2012-06-04 Revised Date: 2013-01-31 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1213-8 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Anesthesiology, Emory University School of Medicine and Emory Healthcare, Atlanta, GA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Antibodies
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blood Anticoagulants / administration & dosage*, adverse effects*, immunology Cardiac Surgical Procedures* / adverse effects Drug Substitution Georgia Hemorrhage / chemically induced Heparin / adverse effects*, immunology Humans Intensive Care Units* Pipecolic Acids / administration & dosage*, adverse effects Platelet Factor 4 / immunology Predictive Value of Tests Retrospective Studies Risk Assessment Risk Factors Thoracic Surgical Procedures* / adverse effects Thrombocytopenia / chemically induced, diagnosis, immunology, prevention & control* Thrombosis / chemically induced, immunology, prevention & control Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Antibodies; 0/Anticoagulants; 0/Pipecolic Acids; 37270-94-3/Platelet Factor 4; 74863-84-6/argatroban; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2013 Jan;145(1):311-2
[PMID:
23244266
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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