Argatroban
- PDF / 142,231 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 88 Downloads / 146 Views
1
S
Prolonged coagulopathy in an elderly patient: case report A 67-year-old woman developed severe, prolonged coagulopathy during perioperative argatroban anticoagulation [route not clearly stated]. The woman, who had a history of heparin-induced thrombocytopenia and end-stage diabetic nephropathy, had been undergoing haemodialysis using argatroban. During a haemodialysis session, she developed atrial fibrillation, hypotension and angina. She was hospitalised and subsequently scheduled for cardiac surgery. Preoperatively, she was mildly anaemic, with a platelet count of 119 000/µL and was in renal failure. Her coagulation profile and liver function were normal. On day 3, she received argatroban at an initial bolus of 0.3 mg/kg, to achieve a target activated coagulation time (ACT) of >400sec. Additional boluses were required (total of 0.44 mg/kg) before she achieved an ACT of 417sec. An infusion of 6 µg/kg/min was commenced. During surgery, more argatroban boluses (total of 0.44 mg/kg) were given, and the infusion was titrated up to 20 µg/kg/min. The infusion rate was reduced to 14 µg/kg/min when her ACT reached 420sec. Argatroban was stopped at the end of surgery, after having received a total dose of 4.0 mg/kg. Postoperative bleeding was difficult to control as her ACT remained at >300sec. Re-exploration was undertaken because of cardiac tamponade. As the cardiac tamponade was released, her ACT decreased to 221sec. Blood was noted to be oozing from the major surgical points, but there was no active bleeding. Bleeding finally stopped and re-exploration was ended. Her ACT reached 138sec 26 hours after argatroban was withdrawn. Despite receiving numerous transfusions, the woman’s platelet count remained at 52 000/µL throughout the perioperative period. Her activated partial thromboplastin time decreased to 52.8sec 2 days after surgery, and her thrombin time and INR reflected similar changes. She was extubated on postoperative day 2. Recovery was gradual and she was transferred to the ward on the seventh postoperative day. Author comment: "[P]rolonged coagulopathy was most likely caused by prolonged argatroban anticoagulation." Azuma K, et al. Difficult management of anticoagulation with argatroban in a patient undergoing on-pump cardiac surgery. Journal of Cardiothoracic and 803061428 Vascular Anesthesia 24: 831-3, No. 5, Oct 2010 - Japan
0114-9954/10/1373-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 15 Oct 2011 No. 1373
Data Loading...
