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Successful Recovery After an Overdose of Argatroban

Clinical Fellow in Hematology and Medical Oncology, Hematology/Oncology Unit, Harvard Medical School, Massachusetts General Hospital, Boston, MA

David J Kuter, MD DPhil

Associate Professor of Medicine, Harvard Medical School; Director of Clinical Hematology, Center for Hematology, Massachusetts General Hospital

Reprints: Dr. Kuter, Center for Hematology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114-2621, fax 617/643-1915, dkuter{at}partners.org

OBJECTIVE: To report the case of a critically ill man with heparin-induced thrombocytopenia (HIT) who received a 125 mg overdose of the direct thrombin inhibitor argatroban.

CASE SUMMARY: A 74-year-old man with a history of Crohn's disease underwent takedown of an ileorectal fistula. He developed HIT postoperatively and was treated with argatroban. He became critically ill and was transferred to the intensive care unit. On postoperative day 24, he accidentally received argatroban 125 mg over 1 hour (26 µg/kg/min). Treatment with fresh frozen plasma (FFP) was effective, and there were no significant complications. The partial thromboplastin time, however, continued to be prolonged 48 hours after the overdose.

DISCUSSION: Medication errors with direct thrombin inhibitors are common. However, there is no known reversal agent for this class of anticoagulants. This patient was treated with FFP and did well, with no bleeding complications. However, the clearance of argatroban was prolonged.

CONCLUSIONS: This case illustrates that supratherapeutic doses of argatroban can be managed with FFP and tolerated without significant complications.

Key Words: argatroban, fresh frozen plasma, overdose

Published Online, January 31, 2006. www.theannals.com, DOI 10.1345/aph.1G494