Document Detail

Recognition of heparin-induced thrombocytopenia and initiation of argatroban therapy after cardiothoracic surgery in the intensive care unit.
MedLine Citation:
PMID:  22329977     Owner:  NLM     Status:  MEDLINE    
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.
Linda J Demma; Christopher A Paciullo; Jerrold H Levy
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-02-11
Journal Detail:
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:
Created Date:  2012-04-16     Completed Date:  2012-06-04     Revised Date:  2013-01-31    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1213-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Department of Anesthesiology, Emory University School of Medicine and Emory Healthcare, Atlanta, GA, USA.
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MeSH Terms
Antibodies / blood
Anticoagulants / administration & dosage*,  adverse effects*,  immunology
Cardiac Surgical Procedures* / adverse effects
Drug Substitution
Hemorrhage / chemically induced
Heparin / adverse effects*,  immunology
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
Reg. No./Substance:
0/Antibodies; 0/Anticoagulants; 0/Pipecolic Acids; 37270-94-3/Platelet Factor 4; 74863-84-6/argatroban; 9005-49-6/Heparin
Comment In:
J Thorac Cardiovasc Surg. 2013 Jan;145(1):311-2   [PMID:  23244266 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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