Minimal Prolongation of Prothrombin Time with Extended Exposure to Argatroban
Minimal Prolongation of Prothrombin Time with Extended Exposure to Argatroban
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DOI：
10.1002/phar.1613
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发表时间：
2015-07-01
期刊：
影响因子：
4.1
通讯作者：
Ito, Satoru
中科院分区：
文献类型：
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作者：
McAlister, Renee K.;Ito, Satoru
在急性肝素诱导的血小板减少症（HIT）的情况下，阿加曲班是首选的初始抗凝剂之一，最终在5天或更长时间内与华法林桥接。阿加曲班降低凝血酶原时间（PT）并增加国际标准化比值（INR）。然而，长期阿加曲班暴露对PT和INR的影响尚不清楚。我们描述了一个不寻常的情况下，长期阿加曲班治疗肝素诱导的血小板减少症伴血栓形成综合征（HITTS）的患者，导致国际标准化比值的最低限度的升高。该患者接受了总共58天的阿加曲班治疗，对华法林治疗耐药，需要13天的过渡期才能达到2.0至3.0的治疗INR。最终，当两种药物的INR均为2.7时，阿加曲班成功过渡至华法林治疗，产生了2.4的确证性真实INR。阿加曲班和华法林联合治疗在长期阿加曲班暴露后未使INR增加超过4.0。临床医生应考虑在其他长期使用阿加曲班的病例中出现这种异常反应，并在华法林和阿加曲班联合治疗期间仔细监测INR。在这种情况下，使用其他方法监测抗凝治疗，如显色因子X测定（CFX）可能会有所帮助。
In the setting of acute heparin-induced thrombocytopenia (HIT), argatroban is one of the initial anticoagulants of choice, which is eventually bridged to warfarin over a period of 5 or more days. Argatroban prolongs prothrombin time (PT) and increases international normalized ratio (INR). However, the effects of prolonged argatroban exposure on the PT and INR are not known. We describe an unusual case of prolonged argatroban treatment in a patient with heparin-induced thrombocytopenia with thrombosis syndrome (HITTS) resulting in a minimal elevation of the INR. The patient received a total of 58days of argatroban and was resistant to warfarin therapy, requiring a 13-day bridge to achieve a therapeutic INR of 2.0 to 3.0. Ultimately, argatroban was successfully transitioned to warfarin therapy when the INR was 2.7 on both agents, producing the confirmatory true INR of 2.4. Argatroban and warfarin cotherapy did not increase the INR beyond 4.0 after prolonged argatroban exposure. Clinicians should consider this unusual response in other cases of prolonged argatroban use, and monitor INR carefully during warfarin and argatroban cotherapy. The use of other methods to monitor anticoagulant therapy, such as chromogenic factor X assay (CFX), may be helpful in this setting.