ABSTRACT
ABSTRACT: The traditional hyperosmolar agents used to treat patients with elevated intracranial pressure are mannitol and hypertonic sodium chloride solution. This article focuses on some of the pros and cons of these treatments for managing cerebral edema.
Subject(s)
Intracranial Hypertension , Sodium Chloride , Humans , Mannitol , Saline Solution, Hypertonic , SugarsSubject(s)
Intracranial Hemorrhages/chemically induced , Stroke/drug therapy , Tissue Plasminogen Activator/adverse effects , Aged , Aged, 80 and over , Female , Fibrin Clot Lysis Time , Humans , Intracranial Hemorrhages/diagnostic imaging , Male , Thrombelastography , Tissue Plasminogen Activator/administration & dosage , Tissue Plasminogen Activator/pharmacokineticsABSTRACT
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.