Argatroban Therapy for Antithrombin Deficiency and Mesenteric Thrombosis: Case Report and Review of the Literature

William E. Dager, Robert C. Gosselin, John T Owings

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Antithrombin deficiency is a hypercoagulable state that can increase the risk for thrombosis, especially in the presence of other procoagulant triggers. Unfractionated heparin and low-molecular-weight heparins may not provide effective anticoagulation since they require antithrombin for activity. Direct thrombin inhibitors, however, work independently of antithrombin. A 21-year-old man with a history of heavy alcohol consumption had thrombosis of the superior mesenteric vein. Infusion with unfractionated heparin was started, and despite repeated boluses and increases to 21 U/kg/hour, the maximum activated partial thromboplastin time reached was 39 seconds. The unfractionated heparin was discontinued, and the direct thrombin inhibitor argatroban was infused at rates of 0.4-0.5 pg/kg/minute. Over the course of several weeks, the patient had numerous operations to remove and repair necrotic bowel. When no further surgery was anticipated, warfarin therapy was started; the argatroban infusion was discontinued when the patient reached the therapeutic target international normalized ratio with warfarin. No recurrent thrombosis or major bleeding occurred. Direct thrombin inhibitors, such as argatroban, seem to be suitable alternatives for acute anticoagulation in patients with antithrombin deficiency.

Original languageEnglish (US)
Pages (from-to)659-663
Number of pages5
JournalPharmacotherapy
Volume24
Issue number5 I
DOIs
StatePublished - May 2004

Fingerprint

Antithrombins
Thrombosis
Heparin
Warfarin
Therapeutics
Mesenteric Veins
International Normalized Ratio
Partial Thromboplastin Time
Low Molecular Weight Heparin
argatroban
Alcohol Drinking
Hemorrhage

Keywords

  • Antithrombin deficiency
  • Argatroban
  • Direct thrombin inhibitors
  • Hepatic insufficiency

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Argatroban Therapy for Antithrombin Deficiency and Mesenteric Thrombosis : Case Report and Review of the Literature. / Dager, William E.; Gosselin, Robert C.; Owings, John T.

In: Pharmacotherapy, Vol. 24, No. 5 I, 05.2004, p. 659-663.

Research output: Contribution to journalArticle

@article{5e01aa6516ea4f28aac716ff5f86e575,
title = "Argatroban Therapy for Antithrombin Deficiency and Mesenteric Thrombosis: Case Report and Review of the Literature",
abstract = "Antithrombin deficiency is a hypercoagulable state that can increase the risk for thrombosis, especially in the presence of other procoagulant triggers. Unfractionated heparin and low-molecular-weight heparins may not provide effective anticoagulation since they require antithrombin for activity. Direct thrombin inhibitors, however, work independently of antithrombin. A 21-year-old man with a history of heavy alcohol consumption had thrombosis of the superior mesenteric vein. Infusion with unfractionated heparin was started, and despite repeated boluses and increases to 21 U/kg/hour, the maximum activated partial thromboplastin time reached was 39 seconds. The unfractionated heparin was discontinued, and the direct thrombin inhibitor argatroban was infused at rates of 0.4-0.5 pg/kg/minute. Over the course of several weeks, the patient had numerous operations to remove and repair necrotic bowel. When no further surgery was anticipated, warfarin therapy was started; the argatroban infusion was discontinued when the patient reached the therapeutic target international normalized ratio with warfarin. No recurrent thrombosis or major bleeding occurred. Direct thrombin inhibitors, such as argatroban, seem to be suitable alternatives for acute anticoagulation in patients with antithrombin deficiency.",
keywords = "Antithrombin deficiency, Argatroban, Direct thrombin inhibitors, Hepatic insufficiency",
author = "Dager, {William E.} and Gosselin, {Robert C.} and Owings, {John T}",
year = "2004",
month = "5",
doi = "10.1592/phco.24.6.659.34745",
language = "English (US)",
volume = "24",
pages = "659--663",
journal = "Pharmacotherapy",
issn = "0277-0008",
publisher = "Pharmacotherapy Publications Inc.",
number = "5 I",

}

TY - JOUR

T1 - Argatroban Therapy for Antithrombin Deficiency and Mesenteric Thrombosis

T2 - Case Report and Review of the Literature

AU - Dager, William E.

AU - Gosselin, Robert C.

AU - Owings, John T

PY - 2004/5

Y1 - 2004/5

N2 - Antithrombin deficiency is a hypercoagulable state that can increase the risk for thrombosis, especially in the presence of other procoagulant triggers. Unfractionated heparin and low-molecular-weight heparins may not provide effective anticoagulation since they require antithrombin for activity. Direct thrombin inhibitors, however, work independently of antithrombin. A 21-year-old man with a history of heavy alcohol consumption had thrombosis of the superior mesenteric vein. Infusion with unfractionated heparin was started, and despite repeated boluses and increases to 21 U/kg/hour, the maximum activated partial thromboplastin time reached was 39 seconds. The unfractionated heparin was discontinued, and the direct thrombin inhibitor argatroban was infused at rates of 0.4-0.5 pg/kg/minute. Over the course of several weeks, the patient had numerous operations to remove and repair necrotic bowel. When no further surgery was anticipated, warfarin therapy was started; the argatroban infusion was discontinued when the patient reached the therapeutic target international normalized ratio with warfarin. No recurrent thrombosis or major bleeding occurred. Direct thrombin inhibitors, such as argatroban, seem to be suitable alternatives for acute anticoagulation in patients with antithrombin deficiency.

AB - Antithrombin deficiency is a hypercoagulable state that can increase the risk for thrombosis, especially in the presence of other procoagulant triggers. Unfractionated heparin and low-molecular-weight heparins may not provide effective anticoagulation since they require antithrombin for activity. Direct thrombin inhibitors, however, work independently of antithrombin. A 21-year-old man with a history of heavy alcohol consumption had thrombosis of the superior mesenteric vein. Infusion with unfractionated heparin was started, and despite repeated boluses and increases to 21 U/kg/hour, the maximum activated partial thromboplastin time reached was 39 seconds. The unfractionated heparin was discontinued, and the direct thrombin inhibitor argatroban was infused at rates of 0.4-0.5 pg/kg/minute. Over the course of several weeks, the patient had numerous operations to remove and repair necrotic bowel. When no further surgery was anticipated, warfarin therapy was started; the argatroban infusion was discontinued when the patient reached the therapeutic target international normalized ratio with warfarin. No recurrent thrombosis or major bleeding occurred. Direct thrombin inhibitors, such as argatroban, seem to be suitable alternatives for acute anticoagulation in patients with antithrombin deficiency.

KW - Antithrombin deficiency

KW - Argatroban

KW - Direct thrombin inhibitors

KW - Hepatic insufficiency

UR - http://www.scopus.com/inward/record.url?scp=2342624555&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2342624555&partnerID=8YFLogxK

U2 - 10.1592/phco.24.6.659.34745

DO - 10.1592/phco.24.6.659.34745

M3 - Article

C2 - 15162900

AN - SCOPUS:2342624555

VL - 24

SP - 659

EP - 663

JO - Pharmacotherapy

JF - Pharmacotherapy

SN - 0277-0008

IS - 5 I

ER -