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Argatroban

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Argatroban, Acova

  • See Also
  1. Direct Thrombin Inhibitor
  2. Dabigatran (Pradaxa)
  3. Bivalirudin
  4. Desirudin
  • Indications
  1. Heparin Induced Thrombocytopenia (HIT)
  2. Percutaneous Coronary Intervention (PCI) for patients at risk for HIT
  • Mechanism
  1. See Direct Thrombin Inhibitor
  2. Argatroban is a non-Hirudan (univalent agent)
  • Dosing
  1. Heparin Induced Thrombocytopenia (HIT)
    1. Initial: 2 mcg/kg/minute
    2. Initial lower dose indications
      1. Congestive Heart Failure or Anasarca
      2. Multiorgan failure
      3. Postcardiac surgery
    3. Maintenance: Adjusted per PTT
      1. PTT Target 1.5 to 3 fold over baseline
      2. PTT maximum <100 seconds
    4. Maximum: 10 mcg/kg/min
  2. Percutaneous Coronary Intervention (PCI) for patients at risk for HIT
    1. Bolus 350 mcg/kg IV over 3 to 5 minutes
    2. Maintenance: 25 mcg/kg/min IV
    3. Target Activated Clotting Time (ACT) 300 to 450 sec throughout PCI procedure
      1. ACT <300 sec
        1. Bolus 150 mcg/kg IV
        2. Increase infusion to 30 mcg/kg/min
      2. ACT >450 sec
        1. Decrease infusion to 15 mcg/kg/min
  • Safety
  1. Unknown safety in pregnancy
  2. Contraindicated in Lactation
  • Drug Interactions
  1. Warfarin
    1. Argatroban prolongs INR
    2. INR > 4
      1. Discontinue Argatroban
      2. Recheck INR in 4 to 6 hours and restart Argatroban for subtherapeutic INR
  • Resources
  1. Argatroban (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d9b975bd-e3f4-466e-96ca-7bef7899506d
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Mahat (2022) Argatroban, StatPearls. Treasure Island, FL
    1. https://www.ncbi.nlm.nih.gov/books/NBK555971/