Geriatric or Pediatric Patients

The pharmacokinetic parameters of argatroban are similar between young adults and elderly volunteers (Swan and Hursting, 2000), and no dosage adjustment is required for the elderly. The effectiveness of argatroban in HIT was not influenced by patient age (range, 17 to 91 yr) in the ARG-911 and ARG-915 studies (Lewis et al., 2001, 2006). Age was also not a significant factor determining therapeutic argatroban doses or thrombotic risk for elderly patients aged 65 to 93 yr in a multicenter HIT registry (Bartholomew et al., 2007).

A literature review has described 34 pediatric patients aged 1 wk to 16 yr, most with or at risk of HIT, administered argatroban for prophylaxis or treatment of thrombosis or during a variety of procedures, including cardiac catheterization, hemodialysis, ECMO or ventricular assist device support, and CPB (Hursting et al., 2006). Argatroban generally provided therapeutic levels of anticoagulation; by exception, the bleeding risk during CPB was unacceptably high. A prospective study of argatroban in pediatric patients requiring anticoagulant alternatives to heparin has been conducted in the United States, and results are under regulatory review.

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