AN EVALUATION OF AN ARGATROBAN DOSE TITRATION NOMOGRAM
Abstract number: P-M-649
Koerber1 J.M., Mattson2 J.C., Kennedy3 M., Smythe3 M.A.
11Pharmaceutical Services 22Clinical Pathology, William Beaumont Hospital, Royal Oak 33Pharmacy Practice, Wayne State University, Detroit, United States
How-to-cite Koerber JM, Mattson JC, Kennedy M, Smythe MA. AN EVALUATION OF AN ARGATROBAN DOSE TITRATION NOMOGRAM. J Thromb Haemost 2007; 5 Supplement 2: P-M-649
Introduction: The approved starting dose for argatroban, a direct thrombin inhibitor used for heparin-induced thrombocytopenia, is 2mcg/kg/min. A previous evaluation of dose requirements in our institution found that patients require lower doses of argatroban to achieve a therapeutic activated partial thromboplastin time (aPTT). An argatroban dose titration nomogram was developed and implemented for non-ICU patients with preserved hepatic function. The recommended starting dose of argatroban with the nomogram is 1.2mcg/kg/min. The objective of this study was to evaluate the outcomes of the nomogram.
Methods: After institutional review board approval, patient data were retrospectively collected on patients in whom argatroban was begun at a dose of 1.2mcg/kg/min. Argatroban use was assessed from initiation of argatroban therapy until the first aPTT after completion of 48 hours or cessation of argatroban, whichever came first. Outcomes included aPTT data, argatroban dose changes and major bleeding events. New thrombotic events were assessed from the time of argatroban initiation through hospital discharge.
Results: Twenty-three patients were evaluated. Mean age and creatinine clearance were 68.016.0 years and 62.026.6 ml/min, respectively. The mean duration of argatroban therapy assessed was 53.410.2 hours. Nearly all patients achieved a therapeutic aPTT. Outcome data are shown below:
| || |
|Initial aPTT Result (seconds)||51.714.7*|
|Mean aPTT Ratio||1.90.4*|
|Dose Changes to Reach Therapeutic aPTT (#)||0.10.3*|
|Time to First Therapeutic aPTT (hours)||7.36.0*|
|% therapeutic aPTT ratios||77.331.9*|
|Thrombotic Event, n(%)||1 (4.3)|
|Major Bleeding Event, n(%)||1 (4.3)|
|*mean standard deviation.|
Conclusions: With our argatroban dose titration nomogram over 90% of patients achieved a therapeutic aPTT on a dose approximately 40% lower than the recommended initial dose. Effective anticoagulation was supported by a lower rate of thrombotic events than shown in the argatroban clinical trials. Major bleeding was seen in 4.3% of patients.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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