Critical Care Medicine: Volume 32(4) April 2004 pp 976-980
Stroke in patients with heparin-induced thrombocytopenia and the effect of argatroban therapy
LaMonte, Marian P. MD, MSN; Brown, Philip M. MD, JD; Hursting, Marcie J. PhD
From the University of Maryland School of Medicine (MPL), Baltimore, MD; Encysive Pharmaceuticals (PMB), Houston, TX; and Clinical Science Consulting (MJH), Potomac, MD.
Supported, in part, by Encysive Pharmaceuticals, Houston, TX, and GlaxoSmithKline, Philadelphia, PA.
Address requests for reprints to: Marian P. LaMonte, MD, MSN, University of Maryland School of Medicine, 22 South Greene Street, Room N4W46, Baltimore, MD 21201-1595. E-mail:
mlamonte@umm.edu
Argatroban therapy vs. control significantly reduces the likelihood of new stroke and stroke-associated mortality in heparin-induced thrombocytopenia without increasing intracranial hemorrhage.
Abstract
Objective: To investigate the frequency, mortality rate, and characteristics of stroke in heparin-induced thrombocytopenia and the effect of argatroban therapy in that setting.
Design: Retrospective analysis of two prospective studies of argatroban therapy in heparin-induced thrombocytopenia.
Setting: Hospitalized care.
Patients: Patients were 960 patients with heparin-induced thrombocytopenia (767 argatroban-treated patients, 193 historical controls).
Interventions: Argatroban 2 μg·kg
-1·min
-1, adjusted to achieve activated partial thromboplastin times 1.5-3 times baseline
Measurements and Main Results: Case records were reviewed to identify patients with stroke present at or within 37 days of study entry and to assess 37-day outcomes. Stroke occurred in 30 (3.1%) patients (stroke at entry, n = 9; new stroke during follow-up, n = 24; more than one stroke, n = 4). By logistic regression with treatment, protocol, age, and gender as covariates, females were significantly more likely to suffer stroke (odds ratio, 2.48; 95% confidence interval, 1.11-5.53;
p = .026) and stroke-associated mortality (odds ratio, 4.10; 95% CI, 1.12-15.01;
p = .033), and argatroban-treated patients had significantly reduced odds, vs. control, of new stroke (odds ratio, 0.31; 95% confidence interval, 0.10-0.96;
p = .041) and stroke-associated mortality (odds ratio, 0.18; 95% confidence interval, 0.03-0.92;
p = .039). Stroke (odds ratio, 3.66; 95% confidence interval, 1.73-7.73;
p < .001) and age (odds ratio per year, 1.017; 95% confidence interval, 1.004-1.029;
p = .008) were significant predictors of all-cause death. In the argatroban group, baseline platelet counts were significantly less in patients with, vs. without, stroke (medians, 42 × 10
9/L vs. 72 × 10
9/L;
p = .006). Of 35 stroke events, 33 (94%) were ischemic and two (6%) were hemorrhagic (one per group, none during argatroban infusion); 30 (86%) were present at or within 13 days of entry.
Conclusions: Stroke, particularly ischemic stroke, is common in heparin-induced thrombocytopenia and significantly increases mortality risk. Stroke in heparin-induced thrombocytopenia occurs most often in females, in patients with more severe thrombocytopenia, and within 2 wks of heparin-induced thrombocytopenia presentation. Argatroban therapy vs. control significantly reduces the likelihood of new stroke and stroke-associated mortality in heparin-induced thrombocytopenia without increasing intracranial hemorrhage.
You are currently accessing this Site as a guest. Please login or register by clicking Here
Linear Mode
