Argatroban Administration as an Anticoagulant on Extracorporeal Membrane Oxygenation : A Case Report
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Objective : To present a case report describing the application of low dose argatroban for anticoagulation during extracorporeal membrane oxygenation (ECMO) and its infusion admixture stability. Summary : A 34-year-old woman with a history of decompensated cardiomyopathy was hospitalized to a cardiac intensive care unit and given ECMO. Her platelet count dropped from 191,000 to 53,000 cells/mcL suggesting heparin induced type 1 thrombocytopenia (HIT) 5 days after the initiation of heparin for ECMO anticoagulation. 4T score was 6 points; anti-Heparin/PF4 test was returned negative, and there was no evidence of thrombosis. Heparin was substituted by argatroban with target activated partial thromboplastin (aPTT) of 60-86 seconds. The infused dosage range was 0.15-0.55 mcg/kg/min, at which anticoagulation was adequately maintained. Argatroban intravenous admixtures were made by mixing 20 mg argatroban in 5% dextrose (5%DW), 100 mL or 40 mg in 5%DW for a final concentration of 0.2 mg/mL. No floating particles, turbidity or crystals were 200 mL observed in the admixture. ECMO anticoagulation was well maintained all over the time so duration of oxygenator membrane use was longer than manufacturer’s recommendation. Conclusion : A patient with ECMO was successfully anticoagulated with a low dose of argatroban and its infusion admixture was more diluted than the manufacturer’s recommendation.
Abstract
Objective : To present a case report describing the application of low dose argatroban for anticoagulation during extracorporeal membrane oxygenation (ECMO) and its infusion admixture stability. Summary : A 34-year-old woman with a history of decompensated cardiomyopathy was hospitalized to a cardiac intensive care unit and given ECMO. Her platelet count dropped from 191,000 to 53,000 cells/mcL suggesting heparin induced type 1 thrombocytopenia (HIT) 5 days after the initiation of heparin for ECMO anticoagulation. 4T score was 6 points; anti-Heparin/PF4 test was returned negative, and there was no evidence of thrombosis. Heparin was substituted by argatroban with target activated partial thromboplastin (aPTT) of 60-86 seconds. The infused dosage range was 0.15-0.55 mcg/kg/min, at which anticoagulation was adequately maintained. Argatroban intravenous admixtures were made by mixing 20 mg argatroban in 5% dextrose (5%DW), 100 mL or 40 mg in 5%DW for a final concentration of 0.2 mg/mL. No floating particles, turbidity or crystals were 200 mL observed in the admixture. ECMO anticoagulation was well maintained all over the time so duration of oxygenator membrane use was longer than manufacturer’s recommendation. Conclusion : A patient with ECMO was successfully anticoagulated with a low dose of argatroban and its infusion admixture was more diluted than the manufacturer’s recommendation.
참고문헌 (11)
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