Comparison of a predefined dose increment nomogram to a percentage adjustment nomogram in patients receiving argatroban therapy

Abstract Objective To determine the compliance with a predefined dose increment (PDI) nomogram compared to a percentage adjustment (PA) nomogram for dose titration of argatroban therapy. Methods This was a single-center, retrospective chart review of patients who received argatroban from 2013 to 2016. The primary safety outcome was the percentage of appropriate dose titrations. Secondary safety and efficacy outcomes included median time to therapeutic activated partial thromboplastin time (aPTT), median argatroban dose once therapeutic, and median time in therapeutic, subtherapeutic, and supratherapeutic aPTT range, as well as bleeding and thrombotic events during hospitalization. Results Seventy-seven patients were included in the study. There was no significant difference in the percent of titrations performed appropriately (p=0.17). The median time to goal aPTT, dose when first therapeutic, and time aPTT was subtherapeutic similar in both arms. Patients in the PDI arm were on argatroban for a median of 55 hours vs. 110.5 hours in the PA arm (p=0.0015). Patients in the PA arm spent more time in the therapeutic range (p=0.0006) and less time in the supratherapeutic range (p Conclusion Although, there was no difference in the percent of appropriate dose titrations,patients in the PA arm spent more time on argatroban, had greater time in therapeutic aPTT range, and less time in supratherapeutic aPTT range. Future studies including a larger sample size, matching therapeutic aPTT ranges, and similar initial infusion rates would help further evaluate outcomes between the PDI and PA nomograms.