Safety of Argatroban in critically ill patients with acute kidney injury and renal replacement therapy after cardiac surgery

Objectives: If renal replacement therapy (RRT) is needed after cardiac surgery, unfractionated heparin is used as standard anticoagulant. 0.5–5% of these patients develop a heparin-induced-thrombocytopenia (HIT- II) with the need for alternative anticoagulation. Aim of this retrospective analysis was to evaluate the safety of argatroban anticoagulation during RRT, with special attention to bleeding complications and need for transfusion. Methods: Analysis of data from all patients between March 2007 and August 2009 with suspected or proven HIT-II who received argatroban instead of heparin anticoagulation for RRT. We compared data from patients receiving un-fractioned heparin or argatroban, and of patients who were switched from heparin to argatroban during RRT, respectively. Results: We analyzed data of 105 patients and 779 RRTs: 28 patients received heparin, 51 argatroban and 26 were switched from heparin to argatroban during RRT. Demographic data were not significantly different between these groups. The hemoglobin range in all three groups was between 10.1±1.2 and 10.6±1.3g/dl at the beginning of RRT, and there was no significant difference in the need for transfusion between groups (heparin: 0.3±0.7 erythrocyte and 1.0±1.5 platelet concentrate per day of RRT; argatroban: 0.4±0.6 erythrocyte and 0.7±0.4 platelet concentrate per day of RRT, and patients with switched anticoagulation: 0.4±0.4 erythrocyte and 0.2±0.2 platelet concentrate per day of RRT). Additionally, no severe bleeding complications requiring redo surgery were observed in any group. Conclusion: With respect to bleeding complications, anticoagulation with argatroban in patients on RRT after cardiac surgery seems to be as safe as standard heparin anticoagulation.