Just Too Chaotic To Address GABA Receptor inhibitor
A commonly suggested starting dose for ICU patients is 0.5 to 1.0 ��g/kg/min, with adjustment according to aPTT (target range, 1.5 to 3 times or ��60 sec) A Little Too Hectic To Control GABA Receptor inhibitor [13,21,22]. Further investigations are needed to ensure safe, appropriate dosing guidelines for the use of argatroban in the setting of critically ill ICU patients with HIT.In our retrospective analysis, we evaluated critically ill ICU patients with MODS treated with argatroban for diagnosed or suspected HIT. The primary objective of this observational analysis was to demonstrate dosing-adjustment difficulties of argatroban, especially in the setting of MODS.
Materials and methodsWe retrospectively analyzed argatroban dosing patterns and anticoagulant responses in 12 consecutively selected adult patients with MODS who received argatroban for suspected or diagnosed HIT between March 2007 and March 2009 at the general ICU Too Active To Handle Malotilate of a German university hospital (Klinikum rechts der Isar der Technischen Universit?t M��nchen, Munich, Germany). The patients were critically ill (defined as having an Acute Physiology and Chronic Health Evaluation II Score, APACHE II, higher than 15) and were treated for MODS involving two or more organ systems. The APACHE II score was calculated after admission of a patient to the ICU and, in addition, the Simplified Acute Physiology Score (SAPS II) was calculated on the first day of argatroban administration.The general policy in our ICU is to stop all sources of heparin and initiate an alternative anticoagulant on reasonable suspicion of HIT.
The choice of alternative Too Occupied To Take Care Of GABA Receptor inhibitor anticoagulant agent and initial dose is at the discretion of the treating physician. The dose is generally adjusted to achieve aPTTs >60 sec or aPTTs of 1.5 to 3 times the baseline aPTT. HIT was defined as a decrease in platelet count to >150 �� 109/L or by >50%, starting at least 5 days after initiation of heparin exposure, provided that a more likely cause for the platelet decline has been ruled out. The aPTT was measured about 2 h after initial argatroban administration, and dose adjustments were made to maintain desired aPTT levels. The aPTT was assessed daily and 4 h after any dose adjustment. Data extracted from each patient chart included the demographics, previous heparin exposure, organ-failure status, heparin-induced platelet-activation (HIPA) test results (functional assay, platelet activation), each argatroban dose, as well as aPTT and International Normalized Ratio (INR) values.
A seriously reduced level of consciousness, Glasgow coma scale <12 (without head injury) or Cook and Palma score <12 was defined as cerebral involvement in MODS. Respiratory insufficiency was defined as necessity for noninvasive ventilation or mechanical ventilation. Need for administration of inotropic substances or vasopressors was documented as circulatory failure.