tailieunhanh - Báo cáo y học: "Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective study"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome: a retrospective study. | Saugel et al. Critical Care 2010 14 R90 http content 14 3 R90 c CRITICAL CARE RESEARCH Open Access Argatroban therapy for heparin-induced thrombocytopenia in ICU patients with multiple organ dysfunction syndrome a retrospective study 1 1 2 1 1 Bernd Saugel Veit Phillip Georg Moessmer Roland M Schmid Wolfgang Huber Abstract Introduction Heparin-induced thrombocytopenia HIT is a serious prothrombotic immune-mediated adverse reaction triggered by heparin therapy. When HIT is diagnosed or suspected heparins should be discontinued and an alternative fast-acting parenteral nonheparin anticoagulation such as argatroban should be initiated. Limited and inconsistent data exist about dosing of argatroban in intensive care unit ICU patients with critical illnesses. Methods Retrospective analysis of 12 ICU patients with multiple organ dysfunction syndrome MODS treated with argatroban for suspected or diagnosed HIT. Results The 12 ICU patients with a mean platelet count of 46 000 30 310 had a mean APACHE II score of on ICU admission and a mean SAPS II score of on the first day of argatroban administration. A mean argatroban starting dose of gg kg min min max was used to achieve activated partial thromboplastin times aPTTs 60 sec or aPTTs of to 3 times the baseline aPTT. Adjustment to aPTT required dose reduction in six 50 patients. Patients were treated for a mean of days. The final mean dose in these critically ill patients was gg kg min which is about one eighth of the usually recommended dose and even markedly lower than the previously suggested dose for critically ill ICU patients. In all patients desired levels of anticoagulation were achieved. The mean argatroban dose was significantly lower in patients with hepatic insufficiency compared with patients without hepatic impairment gg kg min versus gg kg min P . The mean argatroban dose was significantly correlated with serum .