Argatroban

Indications

  • Acute Coronary Syndrome (see Coronary Artery Disease, [[Coronary Artery Disease]])
  • Heparin-Induced Thrombocytopenia (HIT) (see Heparin-Induced Thrombocytopenia, [[Heparin-Induced Thrombocytopenia]])
    • Most commonly used agent
    • One of the recommended agents, per Chest 2012 guidelines [MEDLINE])
    • Per Chest 2012 guidelines, this is the preferred agent in the setting of renal insufficiency (grade 2C) [MEDLINE]
  • Venous Thromboembolism
  • Other Indications for Anticoagulation

Pharmacology

  • Synthetic Monovalent Direct Thrombin Inhibitor (see Factor IIa Inhibitors, [[Factor IIa Inhibitors]])
  • Elimination Half-Life: 46 min
  • Metabolism: predominantly hepatic

Administration

  • IV Drip
    • Monitor: PTT (note that INR is also prolonged by argatroban, but is not used to monitor anticoagulation effect with argatroban)
    • Transition from Argatroban to Coumadin: overlap argatroban with Coumadin for 4-5 days, aiming for INR >4, then stop argatroban and recheck INR in 6 hrs
      • In patients with HIT, it may be advisable to aim for INR >5

Effect on Anticoagulation Tests

  • PT/INR: prolonged
  • PTT: prolonged
  • Anti-Factor Xa: no effect

Adverse Effects

Hematologic Adverse Effects

  • Hemorrhage

Other Adverse Effects

  • xxx

References

  • xxx