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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Citation Type

Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review
TLDR
Argatroban appears to be a potential alternative to UFH in patients requiring ECMO and larger prospective studies on well-defined patient populations are warranted to definitively establish its safety, efficacy and ideal dosing strategy.
Use of argatroban for extracorporeal life support in patients with nonheparin-induced thrombocytopenia
TLDR
Argatroban may have a more significant platelet-preserving effect than UFH, regardless of whether HIT is present, and is suggested to be a safe alternative to UFH for patients with non-HIT on ECLS.
Argatroban for Heparin-Induced Thrombocytopenia during Venovenous Extracorporeal Membrane Oxygenation with Continuous Venovenous Hemofiltration.
  • J. Sin, N. Lopez
  • Medicine, Biology
    The journal of extra-corporeal technology
  • 2017
TLDR
The case of a 27-year-old man with severe acute respiratory distress syndrome who developed HIT while on venovenous ECMO with continuous venovenOUS hemofiltration is reported, and the successful use of an argatroban infusion in this setting at much higher doses than what has previously been reported in the adult literature is described.
Anticoagulation with direct thrombin inhibitors during extracorporeal membrane oxygenation
TLDR
Increasing evidence supports DTIs use as safe and effective in extracorporeal membrane oxygenation patients with and without heparin-induced thrombocytopenia, and this review outlines the pharmacology, dosing strategies and available protocols, monitoring parameters, and special use considerations for all available DTIs.
Anticoagulation for Extracorporeal Life Support: Direct Thrombin Inhibitors and Heparin
TLDR
The purpose of this article is to compare these direct thrombin inhibitors (DTIs) bivalirudin and argatroban to the current standard of UNFH anticoagulation during ECLS, to evaluate the current literature surrounding the use of these drugs in ECLs, and to propose therapeutic guidelines for their use.
Bivalirudin Anticoagulation for an Infant with Hyperbilirubinemia and Elevated Plasma-Free Hemoglobin on ECMO.
TLDR
Bivalirudin is a direct thrombin inhibitor that can be used as an alternative anticoagulant in neonates and infants demonstrating inaccurate heparin monitoring in patients placed on ECMO for severe acute respiratory distress syndrome.
Bivalirudin in Pediatric Patients Maintained on Extracorporeal Life Support
  • Erin L Nagle, W. Dager, R. Pretzlaff
  • Medicine
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
  • 2013
TLDR
Bivalirudin, with close monitoring, is a potential option for pediatric patients on extracorporeal life support who have developed heparin-induced thrombocytopenia, hepar in resistance, or significantThrombosis while on heparIn, the largest case series describing the use of a direct thrombin inhibitor in Pediatrics.
Anticoagulation for Extracorporeal Life Support
TLDR
Some of the controversial aspects of anticoagulation monitoring and treatment for patients who require ECLS are presented, some of the current common practices are reviewed, and newer developments in this field are discussed.
Use of bivalirudin as a primary anticoagulant in a child during Berlin Heart EXCOR ventricular assist device support
We describe our experience of bivalirudin use, a newer direct thrombin inhibitor, in an infant who was supported with Berlin Heart EXCOR VAD (Berlin VAD) as bridge to transplant for 122 days without…
Heparin-induced thrombocytopenia during extracorporeal life support: incidence, management and outcomes.
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.
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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.
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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.
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TLDR
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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.
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TLDR
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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.
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TLDR
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