Argatroban for an alternative anticoagulant in HIT during ECMO

• Published in: Journal of intensive care Vol. 5; no. 1; pp. 39 - 5
• Main Authors: Rougé, Alain, Pelen, Felix, Durand, Michel, Schwebel, Carole
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28-06-2017; BioMed Central; BMC
• Subjects: Alcohol; Anticoagulants; Argatroban; Blood oxygenation, Extracorporeal; Blood platelets; Cardiomyopathy; Case Report; Case reports; Catheters; Clinical medicine; Dosage and administration; Drug therapy; Dyspnea; Embolisms; Extracorporeal membrane oxygenation; Heart failure; Heart surgery; Hemodialysis; Heparin-induced thrombocytopenia; Medical imaging; Patients; Pneumonia; Thrombocytopenia; Thrombosis; Argatroban; Extracorporeal membrane oxygenation; Heparin-induced thrombocytopenia
• ISSN: 2052-0492; 2052-0492
• DOI: 10.1186/s40560-017-0235-y

Extracorporeal membrane oxygenation (ECMO) have become more frequently used in daily ICU practice, heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication while on extracorporeal membrane oxygenation (ECMO). HIT confirmation directly impacts on anticoagulant strategy requiring no delay unfractionated heparin discontinuation to be replaced by alternative systemic anticoagulant treatment.
We report two clinical cases of HIT occurring during ECMO in various settings with subsequent recovery with argatroban and provide literature review to help physicians treat HIT during ECMO in clinical daily practice.
HIT during ECMO is uncommon, and despite the absence of recommendation, argatroban seems to be an appropriate and safe therapeutic option. Finally, there are not enough arguments favouring routine circuit change in the event of HIT during ECMO.