Argatroban is an intravenous DTI （direct synthetic thrombin inhibitor） that is not routinely used for anticoagulation; thus, expertise surrounding its use is very limited. Therefore, this case reviews an unusually h...Argatroban is an intravenous DTI （direct synthetic thrombin inhibitor） that is not routinely used for anticoagulation; thus, expertise surrounding its use is very limited. Therefore, this case reviews an unusually high argatroban infusion rate, which was needed to prevent further emboli formation in a patient. In this case, a 61-year-old Caucasian male patient exhibited heparin resistance during an intraoperative vascular procedure as measured by activated clotting time and PTT （partial thromboplastin time）. The patient had multiple occlusions in his right lower extremities and underwent embolectomies of the right popliteal and posterior tibial arteries. The clinical pharmacist was consulted to manage the argatroban infusion once heparin was discontinued. The therapeutic window required a PTr of 1.5-3 times the patient baseline （35-75 s）. The patient was reported to be 89 kg with a baseline PTT of 24.7 s and INR （international normalized ratio） of 0.98. The starting dose ofargatroban was initiated by the pharmacist at 2 mcg/kg/min （10.7 mL/h） as the patient did not have hepatic failure or sepsis. The patient was maintained on argatroban in the therapeutic PTT window for more than 72 h; however, frequent and aggressive dose increases, to a final rate of 7.5 mcg/kg/min （40 mL/h）, were needed to maintain the therapeutic PTT level. From the case, the cause of heparin resistance still has not been determined despite a hematologic work-up; however, this patient required an unusually high infusion rate of argatroban to maintain a therapeutic PTT during the hospital course before being changed to an anticoagulation regimen for discharge.展开更多
文摘Argatroban is an intravenous DTI （direct synthetic thrombin inhibitor） that is not routinely used for anticoagulation; thus, expertise surrounding its use is very limited. Therefore, this case reviews an unusually high argatroban infusion rate, which was needed to prevent further emboli formation in a patient. In this case, a 61-year-old Caucasian male patient exhibited heparin resistance during an intraoperative vascular procedure as measured by activated clotting time and PTT （partial thromboplastin time）. The patient had multiple occlusions in his right lower extremities and underwent embolectomies of the right popliteal and posterior tibial arteries. The clinical pharmacist was consulted to manage the argatroban infusion once heparin was discontinued. The therapeutic window required a PTr of 1.5-3 times the patient baseline （35-75 s）. The patient was reported to be 89 kg with a baseline PTT of 24.7 s and INR （international normalized ratio） of 0.98. The starting dose ofargatroban was initiated by the pharmacist at 2 mcg/kg/min （10.7 mL/h） as the patient did not have hepatic failure or sepsis. The patient was maintained on argatroban in the therapeutic PTT window for more than 72 h; however, frequent and aggressive dose increases, to a final rate of 7.5 mcg/kg/min （40 mL/h）, were needed to maintain the therapeutic PTT level. From the case, the cause of heparin resistance still has not been determined despite a hematologic work-up; however, this patient required an unusually high infusion rate of argatroban to maintain a therapeutic PTT during the hospital course before being changed to an anticoagulation regimen for discharge.
