Wednesday, June 17, 2009

Wednesday June 17, 2009
Alternatives for HIT patients on CRRT?

Critically ill patients with Heparin Induced Thrombocytopenia (HIT), requiring continuous renal replacement therapy(CRRT) are limited in their treatment options for anticoagulation to danaparoid and direct thrombin inhibitors (DTI). Danaparoid is no longer available in the US, thus leaving DTIs.

Argatroban and Lepirudin are the most commonly used DTIs. Given the renal elimination, potential accumulation in these patients and potential for antibody formation, Lepirudin is not a favorable choice in HIT patients requiring CRRT. Argatroban, on the other hand, is eliminated hepatically and does not require dose adjustments for CRRT or hemodialysis.



Argatroban dosing:
Initial infusion: 2 microgram/kg/min
Hepatic impairment: 0.5 microgram/kg/min - Titrated to 1.5-2.5 times initial aPTT baseline.





Reference: Click to get abstract

Link A, et al.
Argatroban for anticoagulation in continuous renal replacement therapy - Critical Care Medicine. 37(1):105-110, January 2009

Tang IY, et al.
Argatroban and Renal Replacement Therapy in Patients with Heparin-Induced Thrombocytopenia - Ann Pharmacother 2005;39:231-6