A comparison of argatroban and lepirudin outcomes

Abstract number: P2041

Smythe M.

William Beaumont Hospital, USA

Although data are available to support the use of both argatroban and lepirudin for management of patients with heparin induced thrombocytopenia (HIT), their use has not been comparatively evaluated. The objective of this project was to compare the safety and efficacy outcomes of lepirudin vs. argatroban therapy. Patients who received either direct thrombin inhibitor (DTI) from January 2000 to December 2001 were identified through the pharmacy system database. Medical charts of these patients were retrospectively reviewed and relevant data extracted. A single investigator reviewed all charts. Outcomes compared in all DTI patients included effective anticoagulation (defined as an aPTT ratio above 1.5 in 80% of measurements with <2 dose adjustments), number of dose adjustments per patient, percent of all aPTTs which were therapeutic and major bleeding events (defined as intracranial, retroperitoneal, bleeding into a major prosthetic joint, or overt bleeding associated with a hemoglobin decrease of >OR = 2 g dL^-1 that led to a transfusion of >OR = 2 units). Outcomes compared only in newly diagnosed HIT patients receiving >24 h of DTI therapy included platelet recovery, new thromboembolic (TE) events and mortality. Data were analyzed using the t-test and Fisher's Exact test. Results are shown in the Table 1.

No significant differences were evident in either efficacy or safety outcomes. Lepirudin and argatroban therapy were both associated with effective anticoagulation and platelet recovery. New TE and mortality were similar between groups. There was no significant difference in the rate of major bleeding events.

Table 1