Treatment of pulmonary embolism with argatroban and ultrasound-assisted catheter-directed thrombolysis with alteplase in a patient with heparin-induced thrombocytopenia
Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved..
PURPOSE: Successful ultrasound-assisted catheter-directed thrombolysis (USAT) with low-dose alteplase and argatroban in a patient with bilateral pulmonary embolism (PE) secondary to heparin-induced thrombocytopenia (HIT) is reported.
SUMMARY: HIT is a life-threatening complication associated with a high risk of thromboembolism. Systemic anticoagulation for the treatment of thrombosis may not be sufficient in the presence of PE. Catheter-directed treatment may be indicated in patients with PE and associated right ventricular dysfunction. Literature describing the use of nonheparin anticoagulation with catheter-directed thrombolysis in the setting of HIT, particularly in the context of PE, is limited. A 76-year-old Caucasian woman with recent cardiac surgery was hospitalized with bilateral PE. Unfractionated heparin was initiated, but the patient was switched to argatroban upon suspicion of HIT due to recent heparin exposure. The patient clinically improved and was switched to rivaroxaban on hospital day 7 for long-term anticoagulation. She developed worsening dyspnea on hospital day 9, and a computed tomography angiogram revealed an increased clot burden. On hospital day 12, the patient underwent USAT with alteplase and argatroban using the EkoSonic Endovascular System (EKOS Corporation, Bothell, WA). The catheters and sheaths were removed after approximately 20 hours, and the patient had marked hemodynamic improvement with reduced bilateral pulmonary arterial pressure. She was transitioned to warfarin therapy and discharged on hospital day 19.
CONCLUSION: A woman with HIT and bilateral PE was successfully treated with the combination of argatroban and USAT with alteplase.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2017 |
|---|---|
| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:74 |
|---|---|
| Enthalten in: |
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists - 74(2017), 15 vom: 01. Aug., Seite 1153-1157 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Bethea, Brittany T [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 23.05.2019 Date Revised 09.12.2020 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.2146/ajhp160368 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM274184923 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM274184923 | ||
| 003 | DE-627 | ||
| 005 | 20231225002919.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2017 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.2146/ajhp160368 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0913.xml |
| 035 | |a (DE-627)NLM274184923 | ||
| 035 | |a (NLM)28743779 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Bethea, Brittany T |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Treatment of pulmonary embolism with argatroban and ultrasound-assisted catheter-directed thrombolysis with alteplase in a patient with heparin-induced thrombocytopenia |
| 264 | 1 | |c 2017 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 23.05.2019 | ||
| 500 | |a Date Revised 09.12.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved. | ||
| 520 | |a PURPOSE: Successful ultrasound-assisted catheter-directed thrombolysis (USAT) with low-dose alteplase and argatroban in a patient with bilateral pulmonary embolism (PE) secondary to heparin-induced thrombocytopenia (HIT) is reported | ||
| 520 | |a SUMMARY: HIT is a life-threatening complication associated with a high risk of thromboembolism. Systemic anticoagulation for the treatment of thrombosis may not be sufficient in the presence of PE. Catheter-directed treatment may be indicated in patients with PE and associated right ventricular dysfunction. Literature describing the use of nonheparin anticoagulation with catheter-directed thrombolysis in the setting of HIT, particularly in the context of PE, is limited. A 76-year-old Caucasian woman with recent cardiac surgery was hospitalized with bilateral PE. Unfractionated heparin was initiated, but the patient was switched to argatroban upon suspicion of HIT due to recent heparin exposure. The patient clinically improved and was switched to rivaroxaban on hospital day 7 for long-term anticoagulation. She developed worsening dyspnea on hospital day 9, and a computed tomography angiogram revealed an increased clot burden. On hospital day 12, the patient underwent USAT with alteplase and argatroban using the EkoSonic Endovascular System (EKOS Corporation, Bothell, WA). The catheters and sheaths were removed after approximately 20 hours, and the patient had marked hemodynamic improvement with reduced bilateral pulmonary arterial pressure. She was transitioned to warfarin therapy and discharged on hospital day 19 | ||
| 520 | |a CONCLUSION: A woman with HIT and bilateral PE was successfully treated with the combination of argatroban and USAT with alteplase | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a alteplase | |
| 650 | 4 | |a anticoagulation | |
| 650 | 4 | |a argatroban | |
| 650 | 4 | |a heparin-induced thrombocytopenia | |
| 650 | 4 | |a pulmonary embolism | |
| 650 | 4 | |a ultrasound-assisted thrombolysis | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 650 | 7 | |a Pipecolic Acids |2 NLM | |
| 650 | 7 | |a Platelet Aggregation Inhibitors |2 NLM | |
| 650 | 7 | |a Sulfonamides |2 NLM | |
| 650 | 7 | |a Heparin |2 NLM | |
| 650 | 7 | |a 9005-49-6 |2 NLM | |
| 650 | 7 | |a Arginine |2 NLM | |
| 650 | 7 | |a 94ZLA3W45F |2 NLM | |
| 650 | 7 | |a Tissue Plasminogen Activator |2 NLM | |
| 650 | 7 | |a EC 3.4.21.68 |2 NLM | |
| 650 | 7 | |a argatroban |2 NLM | |
| 650 | 7 | |a IY90U61Z3S |2 NLM | |
| 700 | 1 | |a Elliot, John W |e verfasserin |4 aut | |
| 700 | 1 | |a Richardson, John B |e verfasserin |4 aut | |
| 700 | 1 | |a Ahmed, Mustafa I |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists |d 1995 |g 74(2017), 15 vom: 01. Aug., Seite 1153-1157 |w (DE-627)NLM075145952 |x 1535-2900 |7 nnns |
| 773 | 1 | 8 | |g volume:74 |g year:2017 |g number:15 |g day:01 |g month:08 |g pages:1153-1157 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.2146/ajhp160368 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 74 |j 2017 |e 15 |b 01 |c 08 |h 1153-1157 | ||