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J Thorac Cardiovasc Surg 2006;132:699-700
© 2006 The American Association for Thoracic Surgery

Brief Communication

Anticoagulation with argatroban in patients with heparin-induced thrombocytopenia antibodies after cardiovascular surgery with cardiopulmonary bypass: First results from the ARG-E03 trial

^a Department of Anesthesia, Deutsches Herzzentrum Berlin, Berlin, Germany
^b Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
^c International Institute of Thrombosis and Vascular Diseases, Frankfurt/Main, Germany
^d Department of Clinical Pharmacology, Klinikum, J.W. Goethe-Universität, Frankfurt/Main, Germany.

Received for publication March 16, 2006; revisions received April 5, 2006; accepted for publication April 25, 2006.

^_* Address for reprints: Andreas Koster, MD, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin (Email: koster@dhzb.de).

The first 20% of the full text of this article appears below.

Heparin-induced thrombocytopenia (HIT) is a severe thrombogenic disease requiring the use of alternative anticoagulants. Argatroban is a synthetic monovalent direct thrombin inhibitor hepatically metabolized with a 45-minute half-life.¹ Argatroban is the only anticoagulant indicated for prophylaxis and treatment of thrombosis in patients with HIT. However, there are scant data regarding use of argatroban in patients with HIT after cardiovascular surgery with cardiopulmonary bypass (CPB). We report on postoperative argatroban in 14 patients with HIT antibodies who underwent cardiovascular surgery with CPB.

Patients and Methods

The European ARG-E03 trial is a multicenter, open-label trial assessing argatroban as a replacement for heparin in patients with a history of HIT or suspected HIT. After ethics committee approval and having obtained informed consent, we enrolled 20 patients from our center. Four patients underwent procedures without CPB. Two of the patients undergoing CPB were treated according to the original protocol with an argatroban starting dose of 2 µg · kg^–1 · min^–1, and an activated partial thromboplastin time (aPTT) overshoot to values exceeding 80 seconds was observed. Therefore the starting dose was reduced to 0.8 to 1 µg · kg^–1 · min^–1 for further patients. We report on the 14 patients who underwent CPB procedures with this protocol.

Results

There were 9 female and 5 male patients with HIT antibodies present before surgical intervention, with a mean age of 61.2 ± 14.7 years . . . [Full Text of this Article]

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