{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T23:11:06Z","timestamp":1784589066318,"version":"3.55.0"},"reference-count":11,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nHeparin-induced thrombocytopenia or heparin-induced hypersensitivity reactions pose a challenge for periprocedural anticoagulation. Direct thrombin inhibitors are an alternative anticoagulant; however, limited literature is available regarding argatroban use in neurovascular procedures.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nWe describe a patient with symptomatic carotid stenosis undergoing angiography and stent placement with an attempted argatroban loading bolus. Stenting was aborted because of plaque morphology, and therapeutic anticoagulation was not reached. The patient underwent carotid endarterectomy with a higher-dose argatroban administration protocol given the previous subtherapeutic anticoagulation during angiography. Argatroban bolus (150 \u00b5g\/kg) and maintenance infusion (5 \u00b5g\/kg\/min) with argatroban irrigation (0.5 mg\/mL, 250 mL total prepared) were used without complication.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nWe reviewed the safety of argatroban in reports from eight institutions, including intraoperative use for eight patients and periprocedural use for 178 patients. Reports demonstrated no argatroban-related complications.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_560_2025","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T09:42:42Z","timestamp":1754041362000},"page":"320","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Safety of argatroban to address heparin hypersensitivity in open and interventional carotid procedures"],"prefix":"10.25259","volume":"16","author":[{"given":"Tyler S.","family":"Cole","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States"},{"name":"Department of Neurosurgery, University of California, San Francisco, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan W.","family":"Koester","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri","family":"Benner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua S.","family":"Catapano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe C.","family":"Albuquerque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Lawton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew F.","family":"Ducruet","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"10.25259\/SNI_560_2025\/ref-1","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1136\/neurintsurg-2013-010712","article-title":"Role of argatroban during neurointerventional procedures in patients with heparin induced thrombocytopenia","volume":"6","author":"Alaraj","year":"2014","journal-title":"J Neurointerv Surg"},{"key":"10.25259\/SNI_560_2025\/ref-2","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1177\/0018578719890091","article-title":"Cost-effectiveness of argatroban versus heparin anticoagulation in adult extracorporeal membrane oxygenation patients","volume":"56","author":"Cho","year":"2021","journal-title":"Hosp Pharm"},{"key":"10.25259\/SNI_560_2025\/ref-3","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1213\/01.ANE.0000146940.47989.5F","article-title":"The use of argatroban for carotid endarterectomy in heparin-induced thrombocytopenia","volume":"100","author":"Hallman","year":"2005","journal-title":"Anesth Analg"},{"key":"10.25259\/SNI_560_2025\/ref-4","first-page":"913","article-title":"Carotid tissue levels of argatroban after direct local delivery during carotid endarterectomy to prevent perioperative cerebral embolism","volume":"56","author":"Kawamata","year":"2005","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_560_2025\/ref-5","doi-asserted-by":"crossref","first-page":"e341","DOI":"10.1016\/j.wneu.2019.08.151","article-title":"Safety and feasibility of using argatroban immediately after mechanical thrombectomy for large artery occlusion","volume":"132","author":"Kim","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_560_2025\/ref-6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13019-015-0214-0","article-title":"Safety and economic considerations of argatroban use in critically ill patients: a retrospective analysis","volume":"10","author":"Kim","year":"2015","journal-title":"J Cardiothorac Surg"},{"key":"10.25259\/SNI_560_2025\/ref-7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/000331979804900108","article-title":"The first report of successful carotid stent implant using argatroban anticoagulation in a patient with heparin-induced thrombocytopenia and thrombosis syndrome: a case report","volume":"49","author":"Lewis","year":"1998","journal-title":"Angiology"},{"key":"10.25259\/SNI_560_2025\/ref-8","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1345\/aph.1P709","article-title":"Use of argatroban as a procedural and bridging anticoagulant in a patient undergoing carotid endarterectomy with concomitant atrial fibrillation","volume":"45","author":"Nanda","year":"2011","journal-title":"Ann Pharmacother"},{"key":"10.25259\/SNI_560_2025\/ref-9","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/00006123-199909000-00003","article-title":"Safety and efficacy of fixed-dose heparin in carotid endarterectomy","volume":"45","author":"Poisik","year":"1999","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_560_2025\/ref-10","doi-asserted-by":"crossref","first-page":"222.e15.8","DOI":"10.1016\/j.wneu.2013.01.037","article-title":"Systemic infusion and local irrigation with argatroban effective in preventing clot formation during carotid endarterectomy in a patient with heparin-induced thrombocytopenia","volume":"80","author":"Serrone","year":"2013","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_560_2025\/ref-11","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1159\/000357866","article-title":"Argatroban for preventing occlusion and restenosis after extracranial artery stenting","volume":"71","author":"Zhou","year":"2014","journal-title":"Eur Neurol"}],"container-title":["Surgical Neurology 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