Document Detail


Successful use of argatroban during the third trimester of pregnancy: case report and review of the literature.
MedLine Citation:
PMID:  19025434     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Direct thrombin inhibitors are commonly used anticoagulants in patients with known or suspected heparin-induced thrombocytopenia (HIT). All three direct thrombin inhibitors available in the United States-argatroban, bivalirudin, and lepirudin-are pregnancy category B drugs based on animal studies, but little data are available on the safety of these agents during human pregnancy. Whereas several case reports support the safe use of lepirudin, only one case report has been published with argatroban and none with bivalirudin. We describe a 26-year-old pregnant woman with portal vein thrombosis and thrombocytopenia treated with argatroban for possible HIT during her last trimester. An argatroban infusion was started at 2 microg/kg/minute during her 33rd week of pregnancy, with the dosage titrated based on the activated partial thromboplastin time; infusion rates ranged from 2-8 microg/kg/minute. Treatment continued until her 39th week of pregnancy, when labor was induced. Argatroban therapy was discontinued 7 hours before epidural anesthesia. The patient successfully delivered a healthy male newborn, devoid of any known adverse effects from argatroban. The infant was found to have a small ventricular septal defect and patent foramen ovale at birth, but it is unlikely that these were caused by argatroban since organogenesis occurs in the first trimester. Even though the cause of this patient's thrombocytopenia was later determined to be idiopathic thrombocytopenic purpura, this is an important case that adds to the literature on use of argatroban during pregnancy.
Authors:
Sallie K Young; Hamid A Al-Mondhiry; Sonia J Vaida; Anthony Ambrose; John J Botti
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Pharmacotherapy     Volume:  28     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2009-02-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1531-6     Citation Subset:  IM    
Affiliation:
Department of Pharmacy, The Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA. syoung1@hmc.psu.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Anticoagulants / administration & dosage,  therapeutic use
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Gravidity
Humans
Infant, Newborn
Infusions, Intravenous
Pipecolic Acids / administration & dosage,  therapeutic use*
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, Third*
Purpura, Thrombocytopenic, Idiopathic / drug therapy*
Treatment Outcome
Venous Thrombosis / drug therapy*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Pipecolic Acids; 74863-84-6/argatroban

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


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