BACKGROUND: There is limited experience with the use of argatroban in combination with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor in acute coronary syndrome (ACS) patients with heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI). MATERIALS AND METHODS: This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by TIMI major bleeding) of the argatroban with or without a GPIIb/IIIa inhibitor during PCI. Among 102 consecutive ACS patients (71.6% unstable angina or NSTEMI and 28.4% STEMI) who received argatroban (239 +/- 104 microg/kg bolus, followed by a 17 +/- 11 microg/kg/min infusion) for confirmed or suspected HIT during PCI, 52 patients (51%) received a GPIIb/IIIa inhibitor simultaneously (86% integrilin, 10% tirofiban, 4% abciximab) and 50 patients (49%) did not. RESULTS: There was no difference between the groups in the efficacy endpoint, which occurred in nine patients (17.3%) who received GPIIb/IIIa inhibitor and in eight patients (16%) who did not (P = 0.70). TIMI major bleeding occurred in three (5.8%) patients in the GPIIa/IIIb inhibitor group versus 0 (0%) patients in the argatroban alone group (P = 0.085). CONCLUSION: In patients with suspected or confirmed HIT undergoing PCI for ACS, argatroban with or without GPIIb/IIIa appears to provide adequate anticoagulation and is well tolerated with a low rate of bleeding.
BACKGROUND: There is limited experience with the use of argatroban in combination with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor in acute coronary syndrome (ACS) patients with heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI). MATERIALS AND METHODS: This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by TIMI major bleeding) of the argatroban with or without a GPIIb/IIIa inhibitor during PCI. Among 102 consecutive ACS patients (71.6% unstable angina or NSTEMI and 28.4% STEMI) who received argatroban (239 +/- 104 microg/kg bolus, followed by a 17 +/- 11 microg/kg/min infusion) for confirmed or suspected HIT during PCI, 52 patients (51%) received a GPIIb/IIIa inhibitor simultaneously (86% integrilin, 10% tirofiban, 4% abciximab) and 50 patients (49%) did not. RESULTS: There was no difference between the groups in the efficacy endpoint, which occurred in nine patients (17.3%) who received GPIIb/IIIa inhibitor and in eight patients (16%) who did not (P = 0.70). TIMI major bleeding occurred in three (5.8%) patients in the GPIIa/IIIb inhibitor group versus 0 (0%) patients in the argatroban alone group (P = 0.085). CONCLUSION: In patients with suspected or confirmed HIT undergoing PCI for ACS, argatroban with or without GPIIb/IIIa appears to provide adequate anticoagulation and is well tolerated with a low rate of bleeding.
Authors: A Michael Lincoff; John A Bittl; Neal S Kleiman; Ian J Sarembock; J Daniel Jackman; Sameer Mehta; Mark A Tannenbaum; Alan L Niederman; William B Bachinsky; J Tift-Mann; H Graham Parker; Dean J Kereiakes; Robert A Harrington; Frederick Feit; Elizabeth S Maierson; Derek P Chew; Eric J Topol Journal: Am J Cardiol Date: 2004-05-01 Impact factor: 2.778
Authors: Jeffrey J Popma; Peter Berger; E Magnus Ohman; Robert A Harrington; Cindy Grines; Jeffrey I Weitz Journal: Chest Date: 2004-09 Impact factor: 9.410
Authors: A Michael Lincoff; John A Bittl; Robert A Harrington; Frederick Feit; Neal S Kleiman; J Daniel Jackman; Ian J Sarembock; David J Cohen; Douglas Spriggs; Ramin Ebrahimi; Gadi Keren; Jeffrey Carr; Eric A Cohen; Amadeo Betriu; Walter Desmet; Dean J Kereiakes; Wolfgang Rutsch; Robert G Wilcox; Pim J de Feyter; Alec Vahanian; Eric J Topol Journal: JAMA Date: 2003-02-19 Impact factor: 56.272
Authors: A K Rao; C Pratt; A Berke; A Jaffe; I Ockene; T L Schreiber; W R Bell; G Knatterud; T L Robertson; M L Terrin Journal: J Am Coll Cardiol Date: 1988-01 Impact factor: 24.094