Use of argatroban as a procedural and bridging anticoagulant in a patient undergoing carotid endarterectomy with concomitant atrial fibrillation.

Objective: To describe the use of argatroban as a procedural and bridging anticoagulant in a patient with a previous history of heparin allergy and atrial fibrillation undergoing carotid endarterectomy.

Case Summary: A 78-year-old female with a history of heparin-induced thrombocytopenia (HIT) and multiple medical comorbidities, including atrial fibrillation requiring chronic anticoagulation with warfarin, was found to have greater than 70% stenosis of her left carotid artery by standard duplex imaging. Her warfarin therapy was discontinued as an outpatient approximately 48 hours prior to an elective left carotid endarterectomy and she was started on argatroban 2 μg/kg/min for bridging therapy.