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OBJETIVO: Reportar 4 casos de pacientes que experimentaron anticoagulación excesiva con dosis recomendadas o menores de argatroban durante tratamiento de trombocitopenia tipo II inducida por heparina (HIT II, por sus siglas en inglés) en la unidad de cuidado intensivo cardiotorácica.
RESUMEN DE CASOS: Cuatro pacientes fueron tratados con argatroban después que se confirmó que tenían HIT II después de cirugía cardíaca. En 3 de los pacientes, se inició el tratamiento con dosis recomendadas de 2 µg/kg/min, y en un paciente se inició la terapia con solo 1 µg/kg/min. Todos los 4 pacientes tenían función hepática relativamente normal. En todos los casos, el tiempo parcial de tromboplastina activada (aPTT) resultó ser súper terapéutico, y en 3 pacientes resultó ser de mas de 100 segundos. Adicionalmente, la depuración de argatroban pareció ser prolongada después de su descontinuación.
DISCUSIÓN: No se ha investigado la farmacocinética de argatroban en pacientes con enfermedades críticas. Nuestro reporte de 4 individuos demuestra que hay un potencial de sobre anticoagulación que puede ocurrir en esta población, a pesar de tener función hepática relativamente normal. Una evaluación objetiva de causalidad reveló que los eventos adversos en estos pacientes fueron probablemente causados por la administración de argatroban.
CONCLUSIONES: Se necesita estudios farmacocinéticos formales de argatroban en pacientes con enfermedades críticas para así poder optimizar esta terapia.
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