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Use of argatroban: experiences in continuous renal replacement therapy in critically ill patients after cardiac surgery.
[heparin-induced thrombocytopenia]
Acute
kidney
injury
requiring
renal
replacement
therapy
(
RRT
)
is
a
common
complication
after
cardiac
surgery
,
complicated
by
suspected
or
proven
heparin-induced
thrombocytopenia
(
type
II
)
.
The
present
study
evaluated
the
use
of
argatroban
as
an
anticoagulant
during
continuous
RRT
in
the
early
period
after
cardiac
surgery
.
Argatroban
was
compared
with
unfractionated
heparin
(
UH
)
with
respect
to
bleeding
complications
and
the
effectiveness
of
anticoagulation
.
Patients
requiring
RRT
after
cardiac
surgery
from
March
2007
to
June
2009
were
identified
.
The
effectiveness
of
anticoagulation
was
measured
indirectly
by
the
duration
of
dialysis
filter
use
.
Bleeding
was
defined
as
clinical
signs
of
blood
loss
or
the
need
for
transfusion
.
Of
94
patients
,
41
received
argatroban
,
27
UH
,
and
26
required
conversion
from
UH
to
argatroban
.
In
all
3
subgroups
,
RRT
was
begun
within
a
median
postoperative
period
of
2
.
0
days
.
Similar
levels
of
anticoagulation
were
achieved
with
the
duration
of
the
circuit
and
filter
changed
an
average
of
1
.
1
times
daily
during
RRT
.
Liver
function
was
comparable
in
all
patients
.
Neither
clinically
relevant
signs
of
bleeding
nor
significant
differences
in
the
hemoglobin
levels
or
a
requirement
for
transfusion
were
noted
.
However
,
the
Simplified
Acute
Physiology
Score
II
values
during
dialysis
and
mortality
were
significantly
greater
in
the
patients
initially
receiving
argatroban
compared
with
those
who
received
UH
alone
(
54
±
2
vs
43
±
3
,
P
<
.
001
;
71
%
vs
44
%
,
P
=
.
04
)
.
Argatroban
can
provide
effective
anticoagulation
in
postoperative
cardiac
patients
receiving
continuous
RRT
.
Close
monitoring
and
dose
titration
resulted
in
a
comparable
risk
of
bleeding
for
anticoagulation
with
both
argatroban
and
heparin
,
regardless
of
the
disease
severity
or
impaired
hepatic
function
.