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Thromboprophylaxis with argatroban in critically ill patients with sepsis: a review.
Bachler, Mirjam; Asmis, Lars M; Koscielny, Jürgen; Lang, Thomas; Nowak, Hartmuth; Paulus, Patrick; Schewe, Jens-Christian; von Heymann, Christian; Fries, Dietmar.
  • Bachler M; Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall.
  • Asmis LM; Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
  • Koscielny J; Coagulation Lab and Centre for Perioperative Thrombosis and Hemostasis, Unilabs, Zurich, Switzerland.
  • Lang T; Institute for Transfusion Medicine, Charité-University Hospital, Berlin, Germany.
  • Nowak H; Gerinnungsambulanz Südheide, Hohne.
  • Paulus P; Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.
  • Schewe JC; Department of Anesthesiology and Operative Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, Linz, Austria.
  • von Heymann C; Department of Anesthesiology and Critical Care Medicine, University of Bonn, Bonn.
  • Fries D; Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany.
Blood Coagul Fibrinolysis ; 33(5): 239-256, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1891118
ABSTRACT
During sepsis, an initial prothrombotic shift takes place, in which coagulatory acute-phase proteins are increased, while anticoagulatory factors and platelet count decrease. Further on, the fibrinolytic system becomes impaired, which contributes to disease severity. At a later stage in sepsis, coagulation factors may become depleted, and sepsis patients may shift into a hypo-coagulable state with an increased bleeding risk. During the pro-coagulatory shift, critically ill patients have an increased thrombosis risk that ranges from developing micro-thromboses that impair organ function to life-threatening thromboembolic events. Here, thrombin plays a key role in coagulation as well as in inflammation. For thromboprophylaxis, low molecular weight heparins (LMWH) and unfractionated heparins (UFHs) are recommended. Nevertheless, there are conditions such as heparin resistance or heparin-induced thrombocytopenia (HIT), wherein heparin becomes ineffective or even puts the patient at an increased prothrombotic risk. In these cases, argatroban, a direct thrombin inhibitor (DTI), might be a potential alternative anticoagulatory strategy. Yet, caution is advised with regard to dosing of argatroban especially in sepsis. Therefore, the starting dose of argatroban is recommended to be low and should be titrated to the targeted anticoagulation level and be closely monitored in the further course of treatment. The authors of this review recommend using DTIs such as argatroban as an alternative anticoagulant in critically ill patients suffering from sepsis or COVID-19 with suspected or confirmed HIT, HIT-like conditions, impaired fibrinolysis, in patients on extracorporeal circuits and patients with heparin resistance, when closely monitored.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / Sepsis / Venous Thromboembolism / COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: Blood Coagul Fibrinolysis Journal subject: Vascular Diseases / Hematology Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / Sepsis / Venous Thromboembolism / COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: Blood Coagul Fibrinolysis Journal subject: Vascular Diseases / Hematology Year: 2022 Document Type: Article