In the article, “Non–ST-Segment Elevation Acute Coronary Syndromes: Management Strategies for Optimal Outcomes” (February 2006[suppl]: S8-S34), Susan Housholder-Hughes presents a very good, broad overview of many facets of this syndrome and its management. However, there is some information on anticoagulant and antiplatelet medications that I feel may be misleading and benefit from further clarification.
On page 23, it is stated that direct thrombin inhibitors do not require monitoring; however, they do. Argatroban, lepirudin, and hirudin all must be closely monitored by partial thromboplastin time (PTT) as often as every 2 hours to ensure appropriate dosing. With argatroban, PTT should be checked 2 hours after initiation of the infusion, and 2 hours after any change, then can be decreased to twice daily if at goal range. For lepirudin and hirudin, PTT should be checked 4 hours after initiation or change, then can be decreased to daily if at goal range. Also,...
.svg?versionId=1461)