Argatroban
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Argatroban Supratherapeutic activated partial thromboplastin time: case report
A 56-year-old man exhibited supratherapeutic activated partial thromboplastin time (aPTT) while receiving treatment with argatroban as an anticoagulant therapy. The man had a history of anti-phospholipid syndrome, lupus, chronic kidney disease, chronic anaemia, chronic thrombocytopenia, heparin-induced thrombocytopenia (HIT) and multiple venous thromboembolisms. He was hospitalised due to shortness of breath related with fever and chills (history of HIT was not revealed at the time of admission). Initial laboratory tests showed haemoglobin of 9.4 g/dL, haematocrit of 29.9%, platelet count of 77×109/L, INR of 1.24, aPTT of 76 sec and prothrombin time of 14.5 sec. Subsequently, he was intubated and shifted to ICU. Further examinations showed bilateral pneumonia with pulmonary fibrosis and interstitial processes. His ongoing medications included rivaroxaban, azathioprine, furosemide, docusatesodium, insulin-detemir, methylprednisolone, insulin-aspart, ferrous-sulfate, piperacillin/tazobactam, pantoprazole, linezolid, fentanyl, norepinephrine and fluconazole. His rivaroxaban therapy was stopped, and his treatment was started with argatroban 0.5 µg/kg/min [route not stated]. His aPTT was 66 seconds at the time of argatroban therapy start; the elevated baseline aPTT level was attributed to underlying anti-phospholipid syndrome. However, after the initiation of argatroban, his aPTT increased up to 130 seconds, which was the limit of detection at the hospital. All initial tests showed his aPTT as >130 seconds. Thereafter, the therapy was stopped for 2 days for a lumbar puncture procedure. After the procedure, the man’s argatroban therapy was re-started at a lower dose of 0.25 µg/kg/min. After the aPTT levels remained within the target goal levels with dose adjustments based on the aPTT levels. He also received blood infusion due to chronic anaemia not associated with a bleeding event. Later, he developed profound thrombocytopenia (aetiology not stated). Lab tests showed aPTT of 105 seconds haemoglobin of 8.0 g/dL, haematocrit of 25.6% and platelets of 15×109/L. His argatroban and linezolid were discontinued (aPTT was 105 seconds at this time). Total argatroban therapy duration was 6 days. He remained in the hospital for six more days without any anticoagulation before care was withdrawn. Dooling K, et al. Monitoring and Dosing of Argatroban in a Patient With Antiphospholipid Syndrome. Hospital Pharmacy : Jan 2020. Available from: URL: http:// doi.org/10.1177/0018578720946765
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Reactions 12 Sep 2020 No. 1821
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