Background Extracorporeal membrane oxygenation (ECMO) or pumpless
extracorporeal lung assist (pECLA) requires effective anticoagulation.
Knowledge on the use of argatroban in patients with acute respiratory distress
syndrome (ARDS) undergoing ECMO or pECLA is limited. Therefore, this study
assessed the feasibility, efficacy and safety of argatroban in critically ill
ARDS patients undergoing extracorporeal lung support. Methods This
retrospective analysis included ARDS patients on extracorporeal lung support
who received argatroban between 2007 and 2014 in a single ARDS referral
center. As controls, patients who received heparin were matched for age, sex,
body mass index and severity of illness scores. Major and minor bleeding
complications, thromboembolic events, administered number of erythrocyte
concentrates, thrombocytes and fresh-frozen plasmas were assessed. The number
of extracorporeal circuit systems and extracorporeal lung support cannulas
needed due to clotting was recorded. Also assessed was the efficacy to reach
the targeted activated partial thromboplastin time (aPTT) in the first
consecutive 14 days of therapy, and the controllability of aPTT values is
within a therapeutic range of 50–75 s. Fisher’s exact test, Mann–Whitney U
tests, Friedman tests and multivariate nonparametric analyses for longitudinal
data (MANOVA; Brunner’s analysis) were applied where appropriate. Results Of
the 535 patients who met the inclusion criteria, 39 receiving argatroban and
39 matched patients receiving heparin (controls) were included. Baseline
characteristics were similar between the two groups, including severity of
illness and organ failure scores. There were no significant differences in
major and minor bleeding complications. Rates of thromboembolic events were
generally low and were similar between the two groups, as were the rates of
transfusions required and device-associated complications. The controllability
of both argatroban and heparin improved over time, with a significantly
increasing probability to reach the targeted aPTT corridor over the first days
(p < 0.001). Over time, there were significantly fewer aPTT values below the
targeted aPTT goal in the argatroban group than in the heparin group (p <
0.05). Both argatroban and heparin reached therapeutic aPTT values for
adequate application of extracorporeal lung support. Conclusions Argatroban
appears to be a feasible, effective and safe anticoagulant for critically ill
ARDS patients undergoing extracorporeal lung support
