Dear NVestor,
Patients who get Heparin are monitored with complete blood count(CBC), which includes Hemoglobin, WBCs and platelets. There is no separate monitoring for platelets. In these days of automated blood counting machines, CBC (complete blood count) is done. This monitoring is needed to detect any possible blood loss due to bleeding, with drop in Hemoglobin and possible drop in Platelet counts. If Argatroban (Novastan) is used, CBC will still be done to monitor for bleeding and possible drop in Hemoglobin. Same CBC will also give you platelet count. MONITORING OF PATIENTS, EITHER ON HEPARIN OR ARGATROBAN FOR THEIR ANTI COAGULANT EFFECTS IS DONE BY THE TEST:APTT(activated partial thrombo-plastin time).Whole blood clotting time is not used as a test now a days.
So monitoring of CBC will not be eliminated, but complications of Heparin induced Thrombocytopenia will be reduced, by quickly recognizing the problem and HAVING A REALLY VIABLE alternative of Argatroban, which does not exist today. Low Molecular weight Heparins, available today are not good substitutes for patients with HIT.
I think Argatroban will be used quite a bit, in patients 3-6% patients who develop low platelets with Heparin and possibly patients with Open Heart surgeries, due to short half life of Argatroban (Novastan). Argatroban will be the only drug for use in patients with AT-3 (Anti Thrombin 3) deficiency, since Argtroban is direct inhibitor of Thrombin. Heparin works on AT-3 first and the combination of Heparin-AT3 works on Thrombin. Argatroban bypasses this so it is ideal drug for this situation. But The number of people with AT-3 deficiency are very few. It is an uncommon hereditary disease.
There is no question that Argatroban is superior to Heparin in every respect. At what cost the company markets will determine the extent of its wide spread use. Managed care and HMOs are very nasty bean counters and care very little about welfare of patients, contrary to all their claims. Today 25-30% of health insurence premium dollars go for health care insurence marketing and beaurocracy, not for patient care. Quarterly corporate profits at any cost is the sole thing that matters. Wait for the day when 51% goes for beaurocracy and 49% for patients.
Bharat Barai MD
Hematologist |
