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The dosing and monitoring of argatroban for heparin-induced thrombocytopenia during extracorporeal membrane oxygenation: a word of caution.
[heparin-induced thrombocytopenia]
Heparin-induced
thrombocytopenia
is
a
serious
complication
of
heparin
use
.
Treatment
includes
discontinuation
of
heparin
and
initiation
of
alternative
anticoagulation
therapy
.
In
extracorporeal
membrane
oxygenation
anticoagulation
is
mandatory
,
and
direct
thrombin
inhibitors
(
DTIs
)
have
been
approved
in
these
cases
.
However
,
the
use
and
monitoring
of
DTIs
in
extracorporeal
membrane
oxygenation
patients
is
not
well
described
.
DTI
use
is
also
complicated
by
the
imprecision
of
available
monitoring
tests
and
currently
recommended
dosing
has
been
shown
to
result
in
a
supratherapeutic
anticoagulative
state
.
This
case
report
describes
the
successful
use
of
the
DTI
argatroban
as
an
alternative
anticoagulant
in
a
patient
with
heparin-induced
thrombocytopenia
requiring
extracorporeal
membrane
oxygenation
support
.
