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Diagnosis and Treatment Model of the COVID-19 Rehabilitation Unit
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
For inpatients in the CRU ward with medical diseases and surgical conditions, such as high-risk or medium-high-risk VTE patients, drug prevention can be considered. It is recommended to choose ultra-low molecular weight heparin (LMWH) or directly remove risk factors. The use time of LMWH is 7–10 days. For patients with thrombocytopenia or heparin-induced thrombocytopenia (HIT) during heparin application, argatroban, bivalirudin, rivaroxaban, etc., are recommended.
Medications for endovascular therapy
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Argatroban is a small molecule and is a direct thrombin inhibitor. It may be used intravenously in patients with heparin-induced thrombocytopenia and is US Food and Drug Administration approved for that purpose. It is metabolized in the liver and its half-life is 50 minutes. It may be used in patients with renal dysfunction and can be monitored using partial thromboplastin time. Bivalirudin is also a direct thrombin inhibitor. It has an onset of a few minutes and a half-life of a few minutes and there is significant experience with this agent in coronary trials. Bivalirudin may also be used in patients with heparin-induced thrombocytopenia. This medication must be dose-adjusted for patients with renal insufficiency or renal failure.
Redo carotid endarterectomy
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Systemic heparinization takes place after all the arteries are controlled and dissection is completed. The author gives a bolus of unfractionated heparin sulfate (100 IU/kg) and redoses as necessary, routinely checking the activated clotting time after heparinization and every hour thereafter. In cases of known heparin sensitivity argatroban is used. The author also administers low-molecular-weight dextran 40 via a 50-mL intravenous bolus followed by a maintenance drip at 10 mL/hour overnight, or until the patient can receive oral medications.
A journey through anticoagulant therapies in the treatment of left ventricular thrombus in post-COVID-19 heparin-induced thrombocytopenia: a case report
Published in Hematology, 2022
Alberto Lázaro-García, Inés Martínez-Alfonzo, Rosa Vidal-Laso, Diego Velasco-Rodríguez, Marta Tomás-Mallebrera, Marta González-Rodríguez, Pilar Llamas-Sillero
After 1 h in the ICU, the patient had an inferior and posterior ST-elevation AMI. A transthoracic echocardiogram detected recurrence of the left ventricular thrombus (18 × 15 mm) with akinetic inferior and posterior areas (LVEF 35%–40%). Urgent coronariography was required. Bivalirudin (load of 0.75 mg/kg) was then administered; this was followed by a maintenance infusion during the procedure (1.75 mg/kg/h) [1]. Coronariography did not show new coronary lesions. Afterwards, a reduced maintenance infusion of bivalirudin was continued (0.25 mg/kg/h). A few hours later, bivalirudin was discontinued, and argatroban (0.5 µg/kg/min) was started. Blood tests showed a progressive increase in the levels of cardiac biomarkers, achieving the troponin I peak 24 h later (32.4 ng/mL). No haemorrhagic complications were observed; therefore, argatroban infusion speed was increased.
Investigational drugs for ischemic stroke: what’s in the clinical development pipeline for acute phase and prevention?
Published in Expert Opinion on Investigational Drugs, 2022
Maria Giulia Mosconi, Maurizio Paciaroni, Walter Ageno
‘Argatroban Plus R-tPA for Acute Ischemic Stroke’ (NCT03740958) is an ongoing randomized, phase 4 study investigating for the efficacy and safety of argatroban plus rt-PA in the treatment of AIS. Argatroban is also under investigation in a phase 4, randomized, study to evaluate its clinical efficacy in the treatment of progressive ischemic stroke (PIS) (Clinical Study of Argatroban in the Treatment of Acute Progressive Ischemic Stroke. NCT04275180). Eligible patients are those with AIS and a NIHSS score increased by ≥2 points from the time of index stroke within 48 h of onset. In the experimental group, argatroban is used along with standard of care treatment. The main outcome is good functional prognosis (mRS ≤ 3). Safety outcomes are sICH within 7 days after PIS and cerebral hemorrhage within 7 days after PIS (Table 3).
Heparin-induced thrombocytopenia: pathophysiology, diagnosis and treatment
Published in Expert Review of Hematology, 2021
Anne-Mette Hvas, Emmanuel J Favaloro, Maja Hellfritzsch
As a non-heparin anticoagulant, argatroban holds the advantage that it is primarily metabolized in the liver and only to a minor degree renally eliminated, making it usable in critically ill patients with reduced renal function, in whom both danaparoid and fondaparinux would be contraindicated. Treatment with argatroban needs to be continuously monitored and thereby requires special expertise and often admission within an intensive care unit. However, as argatroban is exclusively used in the treatment of HIT, the drug is rarely administered and routine use and monitoring are often lacking. Also, in non-critically ill HIT patients, a non-heparin anticoagulant therapy that does not need continuous monitoring, and thereby intensive care admission would be preferred and is strongly warranted. While fondaparinux has been steadily increasing in non-critically ill patients with normal, or near-normal, renal function, fondaparinux holds the disadvantage to pose potential cross-reactivity with HIT antibodies and thereby trigger another immunological reaction. Furthermore, the largest study available evaluating fondaparinux for treatment of suspected HIT revealed a relatively high proportion of both thromboembolic (16.5%) and of bleeding (21.4%) events during treatment with fondaparinux [92].