Efficacy of a Nurse-Managed Argatroban Dose-Adjustment Protocol in a University Teaching Hospital

• Published in: Hospital pharmacy (Philadelphia) 2012-09, Vol.47 (9), p.712-720
• Main Authors: Young, Sallie K., Riding, Daniel, Antonio, Michael E., Al-Mondhiry, Hamid A.
• Format: Article
• Language: English
• ISSN: 0018-5787; 1945-1253
• DOI: 10.1310/hpj4709-712

Background Argatroban is a direct thrombin inhibitor used in the treatment of heparin-induced thrombocytopenia (HIT). No study has evaluated the safety and efficacy of a nurse-managed argatroban dosing protocol. Methods We performed a retrospective analysis of 151 total admissions (129 patients) in which argatroban infusions were administered before and after protocol implementation. The preprotocol and postprotocol groups consisted of 69 and 68 admissions, respectively. Patients were eligible for inclusion if they were ≥18 years old and received an argatroban drip for any reason in the 2 years prior to or following protocol implementation. Results There were no statistically significant differences in the incidence of clinically overt bleeding (primary study safety endpoint) between groups. There was no difference between groups in the primary efficacy endpoints, the mean number of partial thromboplastin time (aPTT) assessments per day, and dose adjustments. The mean number of sub- and supratherapeutic aPTTs during treatment was higher in the preprotocol group when utilizing the specified range in the preprotocol group and the protocol's aPTT range (45–90 s); the preprotocol and postprotocol groups had an average of 3.4 and 1.04 subtherapeutic aPTTs, respectively (P = .008). Similarly, the preprotocol group had an average of 4.98 supratherapeutic aPTTs, while the postprotocol group had 1.84 (P < .001). There was no difference in duration of argatroban infusion in the preprotocol group compared to the postprotocol group with regard to duration of infusion or final infusion rate. Conclusions This nurse-managed argatroban adjustment protocol provides similar safety and efficacy outcomes and decreased monitoring when pre and post implementation were compared.