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Argatroban dosing requirements in extracorporeal life support and other critically ill populations.
Dingman, J Spencer; Smith, Zachary R; Coba, Victor E; Peters, Michael A; To, Long.
Afiliação
  • Dingman JS; Wesley Medical Center, Wichita, KS, United States of America; Henry Ford Hospital, Detroit, MI, United States of America. Electronic address: james.dingman@wesleymc.com.
  • Smith ZR; Henry Ford Hospital, Detroit, MI, United States of America.
  • Coba VE; Henry Ford Hospital, Detroit, MI, United States of America.
  • Peters MA; Henry Ford Hospital, Detroit, MI, United States of America.
  • To L; Henry Ford Hospital, Detroit, MI, United States of America.
Thromb Res ; 189: 69-76, 2020 05.
Article em En | MEDLINE | ID: mdl-32182522
ABSTRACT
Argatroban is a parenteral direct thrombin inhibitor that requires close monitoring to ensure safety and efficacy. Limited data exist to describe its effect in critically ill patients. This was a retrospective, single-center, cohort study that aimed to compare argatroban dosing requirements in those receiving extracorporeal life support (ECLS), continuous renal replacement therapy (CRRT), or neither. Organ dysfunction was assessed using a modified version of the Sequential Organ Failure Assessment (modSOFA) that incorporated the use of extracorporeal support systems. Eighty patients were included in the study (n = 20, 20, 40 in the ECLS, CRRT, and support-free groups, respectively). The majority of patients were Child-Pugh classification B (73%). Median modSOFA scores were higher in the ECLS (16.5) and CRRT (15.5) groups than in the support-free group (7.5) (P < .001). There was no difference in the primary outcome of first therapeutic argatroban dose between the three groups (0.5 µg/kg/min for each; IQRs 0.25-0.50, 0.11-0.50, and 0.25-0.50, respectively; P = .455). The ECLS group had the lowest mean (0.39 µg/kg/min), minimum (0.20 µg/kg/min), and final (0.43 µg/kg/min) doses. ECLS patients had more supratherapeutic aPTTs and dose changes overall, supporting the need for more frequent anticoagulation monitoring or dose reductions in this population. Total modSOFA score demonstrated a moderate inverse correlation with first therapeutic dose (dose = 0.54 - (modSOFA score × 0.012); R = -0.342, P = .002). Overall, initial argatroban doses of 0.3-0.5 µg/kg/min appear to achieve therapeutic aPTT values in the studied populations.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Trombocitopenia / Oxigenação por Membrana Extracorpórea Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Trombocitopenia / Oxigenação por Membrana Extracorpórea Idioma: En Ano de publicação: 2020 Tipo de documento: Article