Abstract
Heparin-induced thrombocytopenia (HIT) is a serious, prothrombotic, immune-mediated adverse reaction triggered by heparin therapy. When HIT is diagnosed or suspected, heparins should be discontinued, and an alternative, fast-acting, parenteral, nonheparin anticoagulation such as argatroban should be initiated. Limited and inconsistent data exist about dosing of argatroban in intensive care unit (ICU) patients with critical illnesses.Retrospective analysis of 12 ICU patients with multiple organ dysfunction syndrome (MODS) treated with argatroban for suspected or diagnosed HIT.The 12 ICU patients with a mean platelet count of 46,000 +/- 30,310 had a mean APACHE II score of 26.7 +/- 7.8 on ICU admission and a mean SAPS II score of 61.5 +/- 16.3 on the first day of argatroban administration. A mean argatroban starting dose of 0.32 +/- 0.25 microg/kg/min (min, 0.04; max, 0.83) was used to achieve activated partial thromboplastin times (aPTTs) >60 sec or aPTTs of 1.5 to 3 times the baseline aPTT. Adjustment to aPTT required dose reduction in six (50%) patients. Patients were treated for a mean of 5.5 +/- 3.3 days. The final mean dose in these critically ill patients was 0.24 +/- 0.16 microg/kg/min, which is about one eighth of the usually recommended dose and even markedly lower than the previously suggested dose for critically ill ICU patients. In all patients, desired levels of anticoagulation were achieved. The mean argatroban dose was significantly lower in patients with hepatic insufficiency compared with patients without hepatic impairment (0.10 +/- 0.06 microg/kg/min versus 0.31 +/- 0.14 microg/kg/min; P = 0.026). The mean argatroban dose was significantly correlated with serum bilirubin (r = -0.739; P = 0.006).ICU Patients with MODS and HIT can be effectively treated with argatroban. A decrease in the initial dosage is mandatory in this patient population. Further studies are needed to investigate argatroban elimination and dosage adjustments for critically ill patients.
Highlights
In the first paragraph of the introduction, the following sentence “If platelet count decreases to ≥50% or thrombosis occurs between day 5 and 14 of heparin therapy, or both, HIT should be suspected [7]” should be changed to read “If platelet count decreases by ≥50% or thrombosis occurs between day 5 and 14 of heparin therapy, or both, HIT should be suspected [7].”
The following reference was erroneously deleted from the manuscript: “Kodityal S, Nguyen PH, Kodityal A, Sherer J, Hursting MJ, Rice L: Argatroban for suspected heparininduced thrombocytopenia: contemporary experience at a large teaching hospital
J Intensive Care Med 2006, 21(2):86-92”. This reference should be cited in the following text; Introduction, First paragraph: “...leading to limb amputations in 10% to 20% and to death in 20% to 30% of cases [3-6].”
Summary
Correction: Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective study Bernd Saugel*1, Veit Phillip1, Georg Moessmer2, Roland M Schmid1 and Wolfgang Huber1
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