Argatroban anticoagulation in patients with a history of heparin-induced thrombocytopenia

Abstract

Introduction Heparin therapy is not recommended for patients with a history of heparin-induced thrombocytopenia (HIT), except in specialized situations, because this treatment can lead to severe reactions including thrombocytopenia and thrombosis. However, the optimal management of patients with a history of HIT requiring acute anticoagulation has not yet been clarified because of the lack of prospective studies. We evaluated the safety and efficacy of argatroban, a direct thrombin inhibitor, as an anticoagulant in patients with a history of HIT needing acute anticoagulation. Methods Thirty-six patients with a history of serologically confirmed HIT were treated prospectively with argatroban [median (5th–95th percentile) dose of 2.0 (1.0–4.3) μg/kg/min for 4.0 (0.7–8.4) days]. Prospectively defined endpoints included successful anticoagulation (therapeutic activated partial thromboplastin time), and bleeding, new thromboembolic events, or other adverse effects during therapy or within 30 days following its cessation. Results All patients required acute anticoagulation with the most common admission diagnoses being deep venous thrombosis or pulmonary embolism ( n=13) and chest pain or acute coronary syndrome ( n=12). Eleven patients had previously received argatroban therapy for HIT; one patient underwent two treatment courses of argatroban for a history of HIT. The median (5th–95th percentile) time between the past diagnosis of HIT and initiation of argatroban was 7.5 (0.4–114.6) months. All evaluable patients were successfully anticoagulated. No patient had major bleeding, new thromboembolic events, or other adverse effects. There were no adverse events related to reexposure. Conclusions Argatroban can provide safe and effective anticoagulation, on initial or repeat exposure, in patients with a history of HIT.