Safety of argatroban to address heparin hypersensitivity in open and interventional carotid procedures.

Background: Heparin-induced thrombocytopenia or heparin-induced hypersensitivity reactions pose a challenge for periprocedural anticoagulation. Direct thrombin inhibitors are an alternative anticoagulant; however, limited literature is available regarding argatroban use in neurovascular procedures.

Case description: We describe a patient with symptomatic carotid stenosis undergoing angiography and stent placement with an attempted argatroban loading bolus. Stenting was aborted because of plaque morphology, and therapeutic anticoagulation was not reached. The patient underwent carotid endarterectomy with a higher-dose argatroban administration protocol given the previous subtherapeutic anticoagulation during angiography. Argatroban bolus (150 µg/kg) and maintenance infusion (5 µg/kg/min) with argatroban irrigation (0.5 mg/mL, 250 mL total prepared) were used without complication.

Conclusion: We reviewed the safety of argatroban in reports from eight institutions, including intraoperative use for eight patients and periprocedural use for 178 patients. Reports demonstrated no argatroban-related complications.