A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation

@article{Cornell2007ACS,
  title={A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation},
  author={Timothy T. Cornell and Polly L Wyrick and Geoffrey M. Fleming and Deborah A. Pasko and Yong Yun Han and Joseph Custer and Jonathan William Haft and Gail M Annich},
  journal={ASAIO Journal},
  year={2007},
  volume={53},
  pages={460-463}
}
Anticoagulation for extracorporeal life support (ECLS) is routinely achieved using heparin, which can be difficult in patients suspected of having heparin-induced thrombocytopenia. We describe a case series of five patients in which we used argatroban, a direct thrombin inhibitor, as an alternative to heparin for systemic anticoagulation during ECLS in patients suspected to have heparin-induced thrombocytopenia. Argatroban was used to achieve target systemic anticoagulation for activate… 
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TLDR
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TLDR
Patients who develop HIT on VA-EC MO are more likely to experience more severe thrombocytopenia and arterial thromboembolism than those on VV-ECMO, and further research in this area and development of standardized protocols for the monitoring, diagnosis and management of HIT in patients on ECLS support are warranted.
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References

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TLDR
The use of Argatroban in adult ECMO is outlined and includes dosage, monitoring, and patient treatment and a need for alternate drug therapy is required for patients requiring treatment with ECMO.
Argatroban for anticoagulation during cardiopulmonary bypass in an infant
TLDR
An infant with HIT who required anticoagulation during cardiopulmonary bypass for tricuspid valve excision in the treatment of bacterial endocarditis is presented and the direct thrombin inhibitor, argatroban, was successfully used.
Argatroban usage for anticoagulation for ECMO on a post-cardiac patient with heparin-induced thrombocytopenia.
TLDR
A post-Norwood Stage I patient requiring ECMO support using Argatroban as an anticoagulant following diagnosis of heparin-induced thrombocytopenia (HIT) is reported, which summarizes the use ofArgatroban during VAD andECMO support for a patient diagnosed with HIT.
Argatroban as an alternative to heparin in extracorporeal membrane oxygenation circuits
TLDR
Thrombin generation was decreased in circuits anticoagulated with argatroban versus heparin, despite aPTTs being less prolonged, suggesting that argatroBan may be more efficacious than hepar in for anticoAGulation in ECMO.
Heparin-induced thrombocytopenia in a pediatric patient receiving extracorporeal support and treated with argatroban
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  • 2006
TLDR
A pediatric case of HIT with evidence of small-vessel arterial thromboembolism in a 17-month-old child receiving extracorporeal membrane oxygenation and continuous renal replacement therapy successfully treated with argatroban is reported.
Argatroban as Anticoagulant in Cardiopulmonary Bypass in an Infant and Attempted Reversal with Recombinant Activated Factor
TLDR
This is the first report of a patient who experienced a cerebral sinus thrombosis in the posttraumatic period after rFVIIa administration, and conditions with increased thromboembolic risk are considered contraindications for the drug.
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TLDR
A case of HIT type II with evidence of small-vessel arterial thrombosis in a 17-month-old boy receiving ECMO and continuous renal replacement therapy successfully treated with argatroban is reported.
Argatroban as anticoagulant in cardiopulmonary bypass in an infant and attempted reversal with recombinant activated factor VII.
TLDR
A case of HIT in an infant in which Argatroban was used as anticoagulant during cardiopulmonary bypass and the unsuccessful use of recombinant activated factor VII (rF-VIIa) to reverse the anticoAGulant effects postoperatively is reported.
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