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Ikkyung Jang - One of the best experts on this subject based on the ideXlab platform.

  • Safety and efficacy of the Argatroban therapy during the early post-cardiac surgery period
    Journal of Thrombosis and Thrombolysis, 2010
    Co-Authors: Joo Heung Yoon, Robert W. Yeh, Kyung Hun Nam, William D. Hoffman, Arvind K. Agnihotri, Ikkyung Jang
    Abstract:

    Heparin-induced thrombocytopenia (HIT) is associated with a high incidence of vein graft occlusion after cardiac surgery. When HIT is suspected during the post-operative period, current guideline recommends a direct thrombin inhibitor such as Argatroban to be started immediately. The aim of this retrospective study was to evaluate the safety and efficacy of Argatroban in the early period after cardiac surgery. All patients who received Argatroban within 72 h after cardiac surgery from September 2005 to June 2009 from a single center were included. Patient demographics, pre-operative relevant history, intra-operative events and post-operative data were collected and analyzed. The primary endpoints were bleeding, thrombotic complication during or after Argatroban administration, and in-hospital mortality. The study population comprised 31 patients administered Argatroban within 72 h after cardiac surgery. Argatroban was started a mean of 1.7 days after surgery (median dose, 0.66 μg/kg/min; median duration, 5.9 days). Twenty patients (64.5%) experienced bleeding; episode driven entirely by the need for blood transfusion. No new thromboembolic complication occurred during or after Argatroban infusion. One patient died from aspiration pneumonia. Compared to those without bleeding complications, patients who bled had longer operation times and increased use of intra-aortic balloon pump. However, Argatroban therapy including the starting time, median dose, infusion duration, and activated partial thromboplastin times showed no difference between the two groups. In cardiac surgery patients with clinical suspicion of HIT, early postoperative use of Argatroban seems well-tolerated and associated with a low risk of thrombotic events.

  • anticoagulation with the direct thrombin inhibitor Argatroban in patients presenting with acute coronary syndromes
    Catheterization and Cardiovascular Interventions, 2009
    Co-Authors: Robert W. Yeh, Suzanne J Baron, Ignacio Cruzgonzalez, E V Pomerantsev, Joanne L Healy, Iris Mcnulty, Ikkyung Jang
    Abstract:

    Objectives: This study examined the efficacy and safety of the direct thrombin inhibitor Argatroban in patients presenting with acute coronary syndromes undergoing cardiac catheterization. Background: Argatroban is a direct-thrombin inhibitor approved for use in percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. Few studies have examined its use in patients undergoing cardiac catheterization for acute coronary syndromes. We performed a retrospective cohort study of patients presenting with acute coronary syndromes who received Argatroban anticoagulation during cardiac catheterization. Methods: Consecutive patients presenting with acute coronary syndromes who received Argatroban while undergoing cardiac catheterization from 2002 to 2005 were included. Patient characteristics and in-hospital outcomes were examined retrospectively via detailed chart review. The primary endpoints of the study were combined death, myocardial infarction or urgent revascularization, and major bleeding during the index hospitalization. Results: A total of 144 patients presenting with an acute coronary syndrome received Argatroban during cardiac catheterization within the study period: 25% presented with ST-elevation myocardial infarction and 75% presented with non-ST-elevation acute coronary syndrome. The combined endpoint of death, myocardial infarction or urgent revascularization occurred in 13.2% of patients during the hospitalization. Major bleeding occurred in 2.1% of patients. Conclusions: In this cohort of patients presenting with acute coronary syndromes, patients receiving Argatroban during cardiac catheterization had a moderate rate of adverse cardiac events and a very low rate of major bleeding. © 2009 Wiley-Liss, Inc.

  • Impact of renal function on Argatroban therapy during percutaneous coronary intervention
    Journal of Thrombosis and Thrombolysis, 2009
    Co-Authors: M J Hursting, Ikkyung Jang
    Abstract:

    Argatroban, a hepatically metabolized direct thrombin inhibitor, is approved for anticoagulation in patients with or at risk of heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI). We investigated the effect of renal function on Argatroban therapy during PCI. From previous Argatroban studies in PCI, we evaluated relationships between estimated creatinine clearance (CrCl) and activated clotting times (ACTs), dosage, and outcomes in 219 patients with or at risk of HIT (HIT group, n  = 67) or administered glycoprotein IIb/IIIa inhibition (non-HIT group, n  = 152). Patients received an Argatroban bolus (350 mcg/kg, HIT group; 250 or 300 mcg/kg, non-HIT group) then 25–30 mcg/kg/min (adjusted to achieve ACTs 300–450 s, HIT group) or 15 mcg/kg/min (target ACTs 275–325 s, non-HIT group), with additional 150-mcg/kg boluses if needed. Of 219 patients, 55 (25%) had CrCl ≤ 60 ml/min (8 with CrCl ≤ 30 ml/min). Regression analyses detected no association between CrCl (range 7–231 ml/min) and initial ACT (by bolus) or mean infusion dose. Multi-bolus usage was similar in patients with, versus without, CrCl ≤ 60 ml/min. In the non-HIT group, CrCl was associated ( P  = 0.01) with the time to ACT ≤ 160 s after Argatroban cessation (~17 min slower per 30-ml/min CrCl decrease). Eight patients (none with CrCl ≤ 60 ml/min) had ischemic complications. Three patients (1 with CrCl 40 ml/min) experienced major bleeding. Argatroban dose adjustment for renal function appears unnecessary during PCI. Renal dysfunction may be associated with slower (by minutes) ACT effect decay after Argatroban cessation. Argatroban is well tolerated in PCI patients with renal impairment.

  • efficacy and safety of Argatroban in patients with heparin induced thrombocytopenia undergoing endovascular intervention for peripheral arterial disease
    Catheterization and Cardiovascular Interventions, 2008
    Co-Authors: Suzanne J Baron, Robert W. Yeh, Ignacio Cruzgonzalez, Josephine L Healy, E V Pomerantsev, Joseph M Garasic, Douglas E Drachman, Kenneth Rosenfield, Ikkyung Jang
    Abstract:

    Objectives: This study aimed to evaluate the efficacy and safety of Argatroban during percutaneous interventions for peripheral arterial disease (PAD). Background: Endovascular interventions are commonly used in patients with peripheral arterial disease. Heparin is routinely administered during these procedures, but cannot be used in patients with a history of heparin-induced thrombocytopenia (HIT). Argatroban is an approved direct thrombin inhibitor for treatment of patients with HIT. There are currently few data on the efficacy and safety of Argatroban during endovascular interventions for PAD. Methods: Patients who underwent endovascular interventions for PAD on Argatroban between 2002 and 2005 were identified from out database. Efficacy was evaluated using a composite of death, urgent revascularization, and amputation, while safety was assessed by TIMI major bleeding during the index hospitalization. Results: A total of 48 patients undergoing lower extremity revascularization on Argatroban were identified. Thirty two of these patients (67%) had antibody-confirmed HIT and the other 16 (33%) had suspected HIT. A mean dose of Argatroban was 173.5 ± 143 μg/kg bolus, followed by a 10.7 ± 9.64 μg/kg/min infusion during the procedure. Twelve patients (25%) met the composite end point (two deaths, one urgent revascularization, nine amputations because of progressive peripheral arterial disease). TIMI major bleeding occurred in three (6%) patients. Conclusion: In patients with confirmed or suspected HIT undergoing endovascular intervention for PAD, Argatroban appears to be effective and safe. A larger study is warranted to confirm these findings from a single center. © 2008 Wiley-Liss, Inc.

  • efficacy and safety of Argatroban with or without glycoprotein iib iiia inhibitor in patients with heparin induced thrombocytopenia undergoing percutaneous coronary intervention for acute coronary syndrome
    Journal of Thrombosis and Thrombolysis, 2008
    Co-Authors: Ignacio Cruzgonzalez, Robert W. Yeh, Suzanne J Baron, Hikari Watanabe, Masanori Osakabe, Josephine L Healy, Maria Sanchezledesma, Ikkyung Jang
    Abstract:

    There is limited experience with the use of Argatroban in combination with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor in acute coronary syndrome (ACS) patients with heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI). This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by TIMI major bleeding) of the Argatroban with or without a GPIIb/IIIa inhibitor during PCI. Among 102 consecutive ACS patients (71.6% unstable angina or NSTEMI and 28.4% STEMI) who received Argatroban (239 ± 104 μg/kg bolus, followed by a 17 ± 11 μg/kg/min infusion) for confirmed or suspected HIT during PCI, 52 patients (51%) received a GPIIb/IIIa inhibitor simultaneously (86% integrilin, 10% tirofiban, 4% abciximab) and 50 patients (49%) did not. There was no difference between the groups in the efficacy endpoint, which occurred in nine patients (17.3%) who received GPIIb/IIIa inhibitor and in eight patients (16%) who did not (P = 0.70). TIMI major bleeding occurred in three (5.8%) patients in the GPIIa/IIIb inhibitor group versus 0 (0%) patients in the Argatroban alone group (P = 0.085). In patients with suspected or confirmed HIT undergoing PCI for ACS, Argatroban with or without GPIIb/IIIa appears to provide adequate anticoagulation and is well tolerated with a low rate of bleeding.

M J Hursting - One of the best experts on this subject based on the ideXlab platform.

  • Impact of renal function on Argatroban therapy during percutaneous coronary intervention
    Journal of Thrombosis and Thrombolysis, 2009
    Co-Authors: M J Hursting, Ikkyung Jang
    Abstract:

    Argatroban, a hepatically metabolized direct thrombin inhibitor, is approved for anticoagulation in patients with or at risk of heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI). We investigated the effect of renal function on Argatroban therapy during PCI. From previous Argatroban studies in PCI, we evaluated relationships between estimated creatinine clearance (CrCl) and activated clotting times (ACTs), dosage, and outcomes in 219 patients with or at risk of HIT (HIT group, n  = 67) or administered glycoprotein IIb/IIIa inhibition (non-HIT group, n  = 152). Patients received an Argatroban bolus (350 mcg/kg, HIT group; 250 or 300 mcg/kg, non-HIT group) then 25–30 mcg/kg/min (adjusted to achieve ACTs 300–450 s, HIT group) or 15 mcg/kg/min (target ACTs 275–325 s, non-HIT group), with additional 150-mcg/kg boluses if needed. Of 219 patients, 55 (25%) had CrCl ≤ 60 ml/min (8 with CrCl ≤ 30 ml/min). Regression analyses detected no association between CrCl (range 7–231 ml/min) and initial ACT (by bolus) or mean infusion dose. Multi-bolus usage was similar in patients with, versus without, CrCl ≤ 60 ml/min. In the non-HIT group, CrCl was associated ( P  = 0.01) with the time to ACT ≤ 160 s after Argatroban cessation (~17 min slower per 30-ml/min CrCl decrease). Eight patients (none with CrCl ≤ 60 ml/min) had ischemic complications. Three patients (1 with CrCl 40 ml/min) experienced major bleeding. Argatroban dose adjustment for renal function appears unnecessary during PCI. Renal dysfunction may be associated with slower (by minutes) ACT effect decay after Argatroban cessation. Argatroban is well tolerated in PCI patients with renal impairment.

  • reduced Argatroban doses after coronary artery bypass graft surgery
    Annals of Pharmacotherapy, 2008
    Co-Authors: William D. Hoffman, Yvonne Czyz, David Mccollum, M J Hursting
    Abstract:

    Background:The Food and Drug Administration–approved Argatroban dose for heparin-induced thrombocytopenia (HIT) is 2 μg/kg/min (0.5 μg/kg/min in hepatic impairment), adjusted to achieve activated partial thromboplastin time (aPTT) 1.5–3 times baseline. Recent data suggest that reduced doses are required after cardiovascular surgery.Objective:To characterize dosing requirements, aPTTs, factors affecting dosage, and clinical outcomes in patients administered Argatroban after coronary artery bypass graft (CABG) surgery.Methods:Charts of 39 patients who underwent CABG surgery and were administered Argatroban postoperatively for laboratory-confirmed HIT (n = 25), antibody-negative suspected HIT (n = 10), or previous HIT requiring anticoagulation (n = 4) were retrospectively reviewed. Patient characteristics, Argatroban dosing information, aPTTs (target range 45–90 sec), and outcomes were summarized. Regression analyses explored potential effectors of dosage.Results:Patient features, Argatroban dosing patterns,...

  • Argatroban therapy in patients with coronary artery disease and heparin induced thrombocytopenia
    The Cardiology, 2008
    Co-Authors: Ikkyung Jang, M J Hursting, David Mccollum
    Abstract:

    The efficacy of the direct thrombin inhibitor Argatroban was investigated in patients who developed heparin-induced thrombocytopenia following heparin therapy for coronary artery disease. The outcome of 121 patients treated with Argatroban was compared with that of 26 patients in a historical control (i.e. patients who did not receive direct thrombin inhibition therapy). Argatroban, compared with controls, significantly reduced the 37-day composite of death, amputation or new thrombosis (30 versus 50%, p = 0.043), primarily driven by a significant decrease in new thrombosis (10 versus 31%, p = 0.01), and led to less bleeding (4 versus 15%, p = 0.046). Therefore, in patients with coronary artery disease who develop heparin-induced thrombocytopenia, Argatroban provides safe, effective anticoagulation.

  • Argatroban therapy in women with heparin induced thrombocytopenia
    Journal of Womens Health, 2007
    Co-Authors: Ikkyung Jang, M J Hursting, Suzanne J Baron, Eddy Anglade
    Abstract:

    Objectives: Women have increased risk of developing heparin-induced thrombocytopenia (HIT), a serious, immune-mediated prothrombotic condition, and have a worse prognosis when affected. We compared gender differences for treatment and outcomes in HIT patients administered Argatroban therapy. Methods: From a multicenter retrospective registry of Argatroban-treated patients, we identified females (n = 42) and males (n = 50) with clinically diagnosed HIT who were administered Argatroban ≤10 μg/kg/min. Upon diagnosis of HIT, heparin was discontinued. Continuous intravenous Argatroban was instituted, adjusted to achieve activated partial thromboplastin times (aPTTs) 1.5–3 times baseline. Between-gender comparisons were made of Argatroban dosing, aPTT responses, and clinical outcomes (death, amputation, new thrombosis, major bleeding). Results: At baseline, females and males were generally well matched, excepting platelet count (medians, 101 × 109/L vs. 170 × 109/L, p = 0.01), with 9 (21%) females and 19 (38%) ...

  • effects of Argatroban therapy demographic variables and platelet count on thrombotic risks in heparin induced thrombocytopenia
    Chest, 2006
    Co-Authors: Bruce E Lewis, M J Hursting, Diane E Wallis, Robert L Levine, Fred Leya
    Abstract:

    Study objectives We investigated the effects of the direct thrombin inhibitor Argatroban, patient demographics, and the platelet count on thrombotic risks in heparin-induced thrombocytopenia (HIT), a serious thrombotic condition, to determine if Argatroban provides effective antithrombotic therapy in patients with HIT without increasing bleeding. Design We retrospectively analyzed thrombotic outcomes in 882 HIT patients (697 patients receiving mean Argatroban doses of 1.7 to 2.0 μg/kg/min for 5 to 7 days, plus 185 historical control subjects) from previously reported prospective studies. Time-to-event analyses of our primary end point—a thrombotic composite of death due to thrombosis, amputation secondary to HIT-associated thrombosis, or new thrombosis within 37 days—and the individual components were conducted, with hazard ratios estimated for treatment with and without adjustments for patient age, gender, race, weight, and baseline platelet count. Measurements and results Argatroban, vs control, significantly reduced the thrombotic composite risk (HIT: hazard ratio, 0.33; 95% confidence interval [CI], 0.20 to 0.54, p Conclusions Argatroban, vs control, provides effective antithrombotic therapy in patients with HIT, without increasing bleeding. Patients at higher risk for HIT-associated thrombosis include women, nonwhites, and individuals with current HIT-associated thrombosis, lower body weight, or more severe thrombocytopenia.

Bruce E Lewis - One of the best experts on this subject based on the ideXlab platform.

  • effects of Argatroban therapy demographic variables and platelet count on thrombotic risks in heparin induced thrombocytopenia
    Chest, 2006
    Co-Authors: Bruce E Lewis, M J Hursting, Diane E Wallis, Robert L Levine, Fred Leya
    Abstract:

    Study objectives We investigated the effects of the direct thrombin inhibitor Argatroban, patient demographics, and the platelet count on thrombotic risks in heparin-induced thrombocytopenia (HIT), a serious thrombotic condition, to determine if Argatroban provides effective antithrombotic therapy in patients with HIT without increasing bleeding. Design We retrospectively analyzed thrombotic outcomes in 882 HIT patients (697 patients receiving mean Argatroban doses of 1.7 to 2.0 μg/kg/min for 5 to 7 days, plus 185 historical control subjects) from previously reported prospective studies. Time-to-event analyses of our primary end point—a thrombotic composite of death due to thrombosis, amputation secondary to HIT-associated thrombosis, or new thrombosis within 37 days—and the individual components were conducted, with hazard ratios estimated for treatment with and without adjustments for patient age, gender, race, weight, and baseline platelet count. Measurements and results Argatroban, vs control, significantly reduced the thrombotic composite risk (HIT: hazard ratio, 0.33; 95% confidence interval [CI], 0.20 to 0.54, p Conclusions Argatroban, vs control, provides effective antithrombotic therapy in patients with HIT, without increasing bleeding. Patients at higher risk for HIT-associated thrombosis include women, nonwhites, and individuals with current HIT-associated thrombosis, lower body weight, or more severe thrombocytopenia.

  • transitioning from Argatroban to warfarin therapy in patients with heparin induced thrombocytopenia
    Clinical and Applied Thrombosis-Hemostasis, 2005
    Co-Authors: M J Hursting, Bruce E Lewis, Donald E Macfarlane
    Abstract:

    Argatroban, a direct thrombin inhibitor used for thromboprophylaxis or treatment in heparin-induced thrombocytopenia (HIT), is routinely monitored using the activated partial thromboplastin time (aPTT) yet also prolongs the international normalized ratio (INR). Peritransitional INRs, aPTTs, anticoagulant dosing patterns, and outcomes were evaluated in 165 HIT patients who were transitioned, without guidelines, from Argatroban to warfarin therapy. Argatroban (median doses: 1.5-2.0 mcg/kg/min) and warfarin (median dose: 5 mg initially with 3.8 mg/day thereafter) overlapped a median 4 days. Median (5-95th percentile) aPTTs (in seconds) and INRs, respectively, were 59.8 (38.8-82.9) and 3.2 (1.7-7.0) during Argatroban monotherapy, 68.6 (44.5-104) and 5.3 (2.4-16) maximally during cotherapy, 59.9 (38.7-92.2) and 4.0 (2.2-11.6) immediately before Argatroban cessation during cotherapy, and 36.0 (25.6-60.2) and 2.3 (1.3-7.3) within a median 10-12 hours after Argatroban cessation. Major bleeding occurred in 1 (0.6%...

  • Argatroban anticoagulation in conjunction with glycoprotein iib iiia inhibition in patients undergoing percutaneous coronary intervention an open label nonrandomized pilot study
    Journal of Thrombosis and Thrombolysis, 2004
    Co-Authors: Ikkyung Jang, Bruce E Lewis, William H Matthai, Neal S Kleiman
    Abstract:

    Background: Argatroban, a direct thrombin inhibitor, blocks clot-bound thrombin more effectively than does heparin. This multicenter, prospective pilot study evaluated the efficacy and safety of Argatroban in combination with glycoprotein IIb/IIIa inhibition in patients undergoing percutaneous coronary intervention. Methods: Patients (N = 152) received Argatroban as a 250- or 300-μg/kg bolus, followed by a 15-μg/kg/min infusion during percutaneous coronary intervention. An additional 150-μg/kg bolus was administered if activated clotting times 5–15 min after initiating Argatroban were <275 s. Abciximab (N = 150) or double-bolus eptifibatide (N = 2) was administered simultaneously. Results: Median activated clotting times at the beginning and end of the procedure were approximately 300 s. The primary efficacy endpoint—a composite of death, myocardial infarction, or urgent revascularization at 30 days—occurred in 4 (2.6%) patients (no death, 4 myocardial infarctions, and 2 revascularizations). Two (1.3%) patients had major bleeding by the Thrombolysis in Myocardial Infarction criteria (1 retroperitoneal, 1 groin hematoma). Conclusions: Argatroban in combination with glycoprotein IIb/IIIa inhibition appears to provide adequate anticoagulation and be well tolerated with an acceptable bleeding risk for patients undergoing percutaneous coronary intervention. Additional studies are warranted.

  • Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin induced thrombocytopenia
    Catheterization and Cardiovascular Interventions, 2002
    Co-Authors: Bruce E Lewis, M J Hursting, William H Matthai, Marc Cohen, Jeffrey W Moses, Fred Leya, Study Investigators
    Abstract:

    Heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome associated with thrombosis. Alternative anticoagulation to heparin is needed for HIT patients during percutaneous coronary intervention (PCI). We evaluated Argatroban, a direct thrombin inhibitor, for anticoagulation in this setting. Ninety-one HIT patients underwent 112 PCIs while on intravenous Argatroban (25 microg/kg/min [350 microg/kg initial bolus], adjusted to achieve an activated clotting time of 300-450 sec). Primary efficacy endpoints were subjective assessments of the satisfactory outcome of the procedure and adequate anticoagulation during PCI. Among patients undergoing initial PCIs with Argatroban (n = 91), 94.5% had a satisfactory outcome of the procedure and 97.8% achieved adequate anticoagulation. Death (zero patients), myocardial infarction (four patients), or revascularization (four patients) at 24 hr after PCI occurred in seven (7.7%) patients overall. One patient (1.1%) experienced periprocedural major bleeding. For patients who had subsequent hospitalizations (mean separation of 150 days) for repeat PCI using Argatroban anticoagulation (n = 21), there were no unsatisfactory outcomes. Overall, outcomes were comparable with those historically reported for heparin. Argatroban therefore is a reasonable anticoagulant option in this setting, where current options are limited.

  • Argatroban therapy does not generate antibodies that alter its anticoagulant activity in patients with heparin induced thrombocytopenia
    Thrombosis Research, 2002
    Co-Authors: Jeanine M Walenga, M J Hursting, Sarfraz Ahmad, Debra Hoppensteadt, Omer Iqbal, Bruce E Lewis
    Abstract:

    Abstract Heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome that can lead to limb- and life-threatening thrombosis. Argatroban, a small synthetic molecule (Argatroban; GlaxoSmithKline, Philadelphia, PA), and lepirudin, a protein of non-human origin (Refludan; Aventis, Bridgewater, NJ), are direct thrombin inhibitors that have been used successfully for anticoagulant therapy in HIT patients. It has been reported that between 44-74% of lepirudin-treated HIT patients develop drug-specific antibodies that either enhance or suppress the anticoagulant activity of lepirudin. By contrast, there have been no reported patient experiences suggestive of unexpected loss or enhancement of Argatroban's anticoagulant effect in clinical trials, including those in HIT patients, or in postmarketing safety surveillance of over 4,800 patients treated in Japan. To confirm the lack of antibodies in Argatroban-treated patients with HIT, we examined plasma for anticoagulant-altering activity and reviewed dosing patterns of re-exposed patients. Paired, pre-therapy and post-therapy (≥7 days) plasma pools exhibited comparable in vitro anticoagulant responses (aPTT and antithrombin activity) to Argatroban supplementation. Argatroban at 5 μg/mL similarly prolonged aPTTs of normal plasma pretreated with IgG isolated from pre-therapy versus post-therapy plasma ( P >0.6). In trials, mean Argatroban doses during initial therapy versus re-exposure were not different among individuals anticoagulated for the treatment or prophylaxis of thrombosis ( P =0.60) or during percutaneous coronary interventions ( P =0.79), with no discernable pattern of suppression or enhancement of Argatroban anticoagulation. Consistent with the lack of reported patient experiences suggestive of unexpected loss or enhancement of Argatroban's anticoagulant effect across clinical trials and post-marketing safety surveillance, these data support the lack of anti-Argatroban antibodies that affect drug activity in Argatroban-treated HIT patients.

Robert W. Yeh - One of the best experts on this subject based on the ideXlab platform.

  • Safety and efficacy of the Argatroban therapy during the early post-cardiac surgery period
    Journal of Thrombosis and Thrombolysis, 2010
    Co-Authors: Joo Heung Yoon, Robert W. Yeh, Kyung Hun Nam, William D. Hoffman, Arvind K. Agnihotri, Ikkyung Jang
    Abstract:

    Heparin-induced thrombocytopenia (HIT) is associated with a high incidence of vein graft occlusion after cardiac surgery. When HIT is suspected during the post-operative period, current guideline recommends a direct thrombin inhibitor such as Argatroban to be started immediately. The aim of this retrospective study was to evaluate the safety and efficacy of Argatroban in the early period after cardiac surgery. All patients who received Argatroban within 72 h after cardiac surgery from September 2005 to June 2009 from a single center were included. Patient demographics, pre-operative relevant history, intra-operative events and post-operative data were collected and analyzed. The primary endpoints were bleeding, thrombotic complication during or after Argatroban administration, and in-hospital mortality. The study population comprised 31 patients administered Argatroban within 72 h after cardiac surgery. Argatroban was started a mean of 1.7 days after surgery (median dose, 0.66 μg/kg/min; median duration, 5.9 days). Twenty patients (64.5%) experienced bleeding; episode driven entirely by the need for blood transfusion. No new thromboembolic complication occurred during or after Argatroban infusion. One patient died from aspiration pneumonia. Compared to those without bleeding complications, patients who bled had longer operation times and increased use of intra-aortic balloon pump. However, Argatroban therapy including the starting time, median dose, infusion duration, and activated partial thromboplastin times showed no difference between the two groups. In cardiac surgery patients with clinical suspicion of HIT, early postoperative use of Argatroban seems well-tolerated and associated with a low risk of thrombotic events.

  • anticoagulation with the direct thrombin inhibitor Argatroban in patients presenting with acute coronary syndromes
    Catheterization and Cardiovascular Interventions, 2009
    Co-Authors: Robert W. Yeh, Suzanne J Baron, Ignacio Cruzgonzalez, E V Pomerantsev, Joanne L Healy, Iris Mcnulty, Ikkyung Jang
    Abstract:

    Objectives: This study examined the efficacy and safety of the direct thrombin inhibitor Argatroban in patients presenting with acute coronary syndromes undergoing cardiac catheterization. Background: Argatroban is a direct-thrombin inhibitor approved for use in percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. Few studies have examined its use in patients undergoing cardiac catheterization for acute coronary syndromes. We performed a retrospective cohort study of patients presenting with acute coronary syndromes who received Argatroban anticoagulation during cardiac catheterization. Methods: Consecutive patients presenting with acute coronary syndromes who received Argatroban while undergoing cardiac catheterization from 2002 to 2005 were included. Patient characteristics and in-hospital outcomes were examined retrospectively via detailed chart review. The primary endpoints of the study were combined death, myocardial infarction or urgent revascularization, and major bleeding during the index hospitalization. Results: A total of 144 patients presenting with an acute coronary syndrome received Argatroban during cardiac catheterization within the study period: 25% presented with ST-elevation myocardial infarction and 75% presented with non-ST-elevation acute coronary syndrome. The combined endpoint of death, myocardial infarction or urgent revascularization occurred in 13.2% of patients during the hospitalization. Major bleeding occurred in 2.1% of patients. Conclusions: In this cohort of patients presenting with acute coronary syndromes, patients receiving Argatroban during cardiac catheterization had a moderate rate of adverse cardiac events and a very low rate of major bleeding. © 2009 Wiley-Liss, Inc.

  • efficacy and safety of Argatroban in patients with heparin induced thrombocytopenia undergoing endovascular intervention for peripheral arterial disease
    Catheterization and Cardiovascular Interventions, 2008
    Co-Authors: Suzanne J Baron, Robert W. Yeh, Ignacio Cruzgonzalez, Josephine L Healy, E V Pomerantsev, Joseph M Garasic, Douglas E Drachman, Kenneth Rosenfield, Ikkyung Jang
    Abstract:

    Objectives: This study aimed to evaluate the efficacy and safety of Argatroban during percutaneous interventions for peripheral arterial disease (PAD). Background: Endovascular interventions are commonly used in patients with peripheral arterial disease. Heparin is routinely administered during these procedures, but cannot be used in patients with a history of heparin-induced thrombocytopenia (HIT). Argatroban is an approved direct thrombin inhibitor for treatment of patients with HIT. There are currently few data on the efficacy and safety of Argatroban during endovascular interventions for PAD. Methods: Patients who underwent endovascular interventions for PAD on Argatroban between 2002 and 2005 were identified from out database. Efficacy was evaluated using a composite of death, urgent revascularization, and amputation, while safety was assessed by TIMI major bleeding during the index hospitalization. Results: A total of 48 patients undergoing lower extremity revascularization on Argatroban were identified. Thirty two of these patients (67%) had antibody-confirmed HIT and the other 16 (33%) had suspected HIT. A mean dose of Argatroban was 173.5 ± 143 μg/kg bolus, followed by a 10.7 ± 9.64 μg/kg/min infusion during the procedure. Twelve patients (25%) met the composite end point (two deaths, one urgent revascularization, nine amputations because of progressive peripheral arterial disease). TIMI major bleeding occurred in three (6%) patients. Conclusion: In patients with confirmed or suspected HIT undergoing endovascular intervention for PAD, Argatroban appears to be effective and safe. A larger study is warranted to confirm these findings from a single center. © 2008 Wiley-Liss, Inc.

  • efficacy and safety of Argatroban with or without glycoprotein iib iiia inhibitor in patients with heparin induced thrombocytopenia undergoing percutaneous coronary intervention for acute coronary syndrome
    Journal of Thrombosis and Thrombolysis, 2008
    Co-Authors: Ignacio Cruzgonzalez, Robert W. Yeh, Suzanne J Baron, Hikari Watanabe, Masanori Osakabe, Josephine L Healy, Maria Sanchezledesma, Ikkyung Jang
    Abstract:

    There is limited experience with the use of Argatroban in combination with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor in acute coronary syndrome (ACS) patients with heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI). This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by TIMI major bleeding) of the Argatroban with or without a GPIIb/IIIa inhibitor during PCI. Among 102 consecutive ACS patients (71.6% unstable angina or NSTEMI and 28.4% STEMI) who received Argatroban (239 ± 104 μg/kg bolus, followed by a 17 ± 11 μg/kg/min infusion) for confirmed or suspected HIT during PCI, 52 patients (51%) received a GPIIb/IIIa inhibitor simultaneously (86% integrilin, 10% tirofiban, 4% abciximab) and 50 patients (49%) did not. There was no difference between the groups in the efficacy endpoint, which occurred in nine patients (17.3%) who received GPIIb/IIIa inhibitor and in eight patients (16%) who did not (P = 0.70). TIMI major bleeding occurred in three (5.8%) patients in the GPIIa/IIIb inhibitor group versus 0 (0%) patients in the Argatroban alone group (P = 0.085). In patients with suspected or confirmed HIT undergoing PCI for ACS, Argatroban with or without GPIIb/IIIa appears to provide adequate anticoagulation and is well tolerated with a low rate of bleeding.

Suzanne J Baron - One of the best experts on this subject based on the ideXlab platform.

  • anticoagulation with the direct thrombin inhibitor Argatroban in patients presenting with acute coronary syndromes
    Catheterization and Cardiovascular Interventions, 2009
    Co-Authors: Robert W. Yeh, Suzanne J Baron, Ignacio Cruzgonzalez, E V Pomerantsev, Joanne L Healy, Iris Mcnulty, Ikkyung Jang
    Abstract:

    Objectives: This study examined the efficacy and safety of the direct thrombin inhibitor Argatroban in patients presenting with acute coronary syndromes undergoing cardiac catheterization. Background: Argatroban is a direct-thrombin inhibitor approved for use in percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. Few studies have examined its use in patients undergoing cardiac catheterization for acute coronary syndromes. We performed a retrospective cohort study of patients presenting with acute coronary syndromes who received Argatroban anticoagulation during cardiac catheterization. Methods: Consecutive patients presenting with acute coronary syndromes who received Argatroban while undergoing cardiac catheterization from 2002 to 2005 were included. Patient characteristics and in-hospital outcomes were examined retrospectively via detailed chart review. The primary endpoints of the study were combined death, myocardial infarction or urgent revascularization, and major bleeding during the index hospitalization. Results: A total of 144 patients presenting with an acute coronary syndrome received Argatroban during cardiac catheterization within the study period: 25% presented with ST-elevation myocardial infarction and 75% presented with non-ST-elevation acute coronary syndrome. The combined endpoint of death, myocardial infarction or urgent revascularization occurred in 13.2% of patients during the hospitalization. Major bleeding occurred in 2.1% of patients. Conclusions: In this cohort of patients presenting with acute coronary syndromes, patients receiving Argatroban during cardiac catheterization had a moderate rate of adverse cardiac events and a very low rate of major bleeding. © 2009 Wiley-Liss, Inc.

  • efficacy and safety of Argatroban in patients with heparin induced thrombocytopenia undergoing endovascular intervention for peripheral arterial disease
    Catheterization and Cardiovascular Interventions, 2008
    Co-Authors: Suzanne J Baron, Robert W. Yeh, Ignacio Cruzgonzalez, Josephine L Healy, E V Pomerantsev, Joseph M Garasic, Douglas E Drachman, Kenneth Rosenfield, Ikkyung Jang
    Abstract:

    Objectives: This study aimed to evaluate the efficacy and safety of Argatroban during percutaneous interventions for peripheral arterial disease (PAD). Background: Endovascular interventions are commonly used in patients with peripheral arterial disease. Heparin is routinely administered during these procedures, but cannot be used in patients with a history of heparin-induced thrombocytopenia (HIT). Argatroban is an approved direct thrombin inhibitor for treatment of patients with HIT. There are currently few data on the efficacy and safety of Argatroban during endovascular interventions for PAD. Methods: Patients who underwent endovascular interventions for PAD on Argatroban between 2002 and 2005 were identified from out database. Efficacy was evaluated using a composite of death, urgent revascularization, and amputation, while safety was assessed by TIMI major bleeding during the index hospitalization. Results: A total of 48 patients undergoing lower extremity revascularization on Argatroban were identified. Thirty two of these patients (67%) had antibody-confirmed HIT and the other 16 (33%) had suspected HIT. A mean dose of Argatroban was 173.5 ± 143 μg/kg bolus, followed by a 10.7 ± 9.64 μg/kg/min infusion during the procedure. Twelve patients (25%) met the composite end point (two deaths, one urgent revascularization, nine amputations because of progressive peripheral arterial disease). TIMI major bleeding occurred in three (6%) patients. Conclusion: In patients with confirmed or suspected HIT undergoing endovascular intervention for PAD, Argatroban appears to be effective and safe. A larger study is warranted to confirm these findings from a single center. © 2008 Wiley-Liss, Inc.

  • efficacy and safety of Argatroban with or without glycoprotein iib iiia inhibitor in patients with heparin induced thrombocytopenia undergoing percutaneous coronary intervention for acute coronary syndrome
    Journal of Thrombosis and Thrombolysis, 2008
    Co-Authors: Ignacio Cruzgonzalez, Robert W. Yeh, Suzanne J Baron, Hikari Watanabe, Masanori Osakabe, Josephine L Healy, Maria Sanchezledesma, Ikkyung Jang
    Abstract:

    There is limited experience with the use of Argatroban in combination with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor in acute coronary syndrome (ACS) patients with heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI). This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by TIMI major bleeding) of the Argatroban with or without a GPIIb/IIIa inhibitor during PCI. Among 102 consecutive ACS patients (71.6% unstable angina or NSTEMI and 28.4% STEMI) who received Argatroban (239 ± 104 μg/kg bolus, followed by a 17 ± 11 μg/kg/min infusion) for confirmed or suspected HIT during PCI, 52 patients (51%) received a GPIIb/IIIa inhibitor simultaneously (86% integrilin, 10% tirofiban, 4% abciximab) and 50 patients (49%) did not. There was no difference between the groups in the efficacy endpoint, which occurred in nine patients (17.3%) who received GPIIb/IIIa inhibitor and in eight patients (16%) who did not (P = 0.70). TIMI major bleeding occurred in three (5.8%) patients in the GPIIa/IIIb inhibitor group versus 0 (0%) patients in the Argatroban alone group (P = 0.085). In patients with suspected or confirmed HIT undergoing PCI for ACS, Argatroban with or without GPIIb/IIIa appears to provide adequate anticoagulation and is well tolerated with a low rate of bleeding.

  • Argatroban therapy in women with heparin induced thrombocytopenia
    Journal of Womens Health, 2007
    Co-Authors: Ikkyung Jang, M J Hursting, Suzanne J Baron, Eddy Anglade
    Abstract:

    Objectives: Women have increased risk of developing heparin-induced thrombocytopenia (HIT), a serious, immune-mediated prothrombotic condition, and have a worse prognosis when affected. We compared gender differences for treatment and outcomes in HIT patients administered Argatroban therapy. Methods: From a multicenter retrospective registry of Argatroban-treated patients, we identified females (n = 42) and males (n = 50) with clinically diagnosed HIT who were administered Argatroban ≤10 μg/kg/min. Upon diagnosis of HIT, heparin was discontinued. Continuous intravenous Argatroban was instituted, adjusted to achieve activated partial thromboplastin times (aPTTs) 1.5–3 times baseline. Between-gender comparisons were made of Argatroban dosing, aPTT responses, and clinical outcomes (death, amputation, new thrombosis, major bleeding). Results: At baseline, females and males were generally well matched, excepting platelet count (medians, 101 × 109/L vs. 170 × 109/L, p = 0.01), with 9 (21%) females and 19 (38%) ...