Safety of Argatroban Infusion in Conduction Disturbances

Primary objective:

To determine change of corrected QT interval (QTc) during intravenous argatroban infusion in patients undergoing percutaneous coronary intervention (PCI).

Secondary objectives:

• Determination of the QTc interval after sufficient wash-out period by ECG-3 which needed to be performed > 8 but ≤ 28 hours after termination of prolonged argatroban infusion.
• Investigation of dependence of QTc interval on gender and applied doses.
• Determination of coagulation status during argatroban therapy.
• Assessment of safety-related events within the scope of anticoagulation with argatroban, for example bleeding events or thromboembolic events.

Inclusion criteria

• Diagnosis of stable CAD or unstable angina (troponin negative, i.e. within the normal range for the study site) with low to moderate anatomic risk.
• Patient required elective percutaneous coronary angioplasty or stent insertion with an approved device in one or more de novo-treated or re-stenotic lesions in native vessels.
• Patient was on adequate platelet inhibition therapy after having received a loading dose with ASA and clopidogrel before start of intervention (this additional inclusion criterion was introduced with study protocol version 1.6, dated 14.12.2018)
• Willingness to give written informed consent, written consent for data protection (legal requirement in Germany "datenschutzrechtliche Einwilligung") and willingness to participate and to comply with the requirements of the study protocol.
• The patient (female/male) was at least 18 years of age.
• Baseline ECG without changes that impair assessment of QTc interval.

Exclusion criteria

• Patient was indicated for highly complex 3-vessel intervention.
• The female patient was pregnant (exclusion by routine urine test) or was nursing during therapy period.
• Patients who were currently participating in another clinical trial or patients who participated in another clinical trial during the last 3 months prior to study start (date of treatment visit).
• History of drug, alcohol or chemical abuse within 6 months prior to study start.
• Planned surgical intervention other than study procedure within 7 days after study start.
• Any condition, which contraindicated the use of argatroban, or endangered the patient if he/she participated in this study.

Factors influencing QTc interval:

• Marked baseline prolongation of QTc interval (repeated demonstration of a QTc interval > 450 ms at baseline ECG).
• A history of risk factors of Torsade de pointes (e.g. heart failure, hypokalemia, family history of Long QT Syndrome).
• Known intraventricular conduction disturbance.
• Bradycardia: heart rate < 45 min-1.
• Electrolyte level outside normal range (according to laboratory's reference values).
• The use of concomitant medications that interfered with the QTc interval.
• Intake of digitalis within the last 2 weeks before study start.
• Acute myocardial infarction or troponin-positive unstable angina.

Factors inhibiting use of argatroban in this study:

• Intolerance to ingredients of Argatra® (sorbitol).
• Known cirrhosis, hepatitis, clinically significant hepatic disorder at study start and/or history of clinically relevant hepatic disorder.
• Current hepatic disorder indicated by laboratory liver profile at screening: Bilirubin, AST/SGOT, ALT/SGPT, gammaGT > 3.0 times upper limit of the normal (ULN).
• Renal insufficiency indicated by laboratory renal profile at study start: GFR < 35 ml/min.
• Uncontrolled hypertension (defined as blood pressure >180/120 mmHg).
• If any form of heparin was taken prior to study start and aPTT ≥ 35 s.
• Intake of direct oral anticoagulants (DOAC) within 1 month prior to study start.
• If anticoagulants of type of vitamin K antagonists (VKA) were taken prior to study start and INR >1.2.
• Platelet count <125 x 109/l.
• Documented coagulation disorder or bleeding diathesis.
• Uncontrolled haemorrhage within the past 3 months.
• Uncontrolled peptic ulcer disease or gastrointestinal bleeding within the past 3 months.
• Cerebral aneurysm.
• Haemorrhagic stroke or ischaemic stroke in the past 6 months.