II. Indications

  1. Heparin Induced Thrombocytopenia (HIT)
  2. Percutaneous Coronary Intervention (PCI) for patients at risk for HIT

III. Mechanism

  1. See Direct Thrombin Inhibitor
  2. Argatroban is a non-Hirudan (univalent agent)

IV. 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

V. Safety

  1. Unknown safety in pregnancy
  2. Contraindicated in Lactation

VI. 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

VIII. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Mahat (2022) Argatroban, StatPearls. Treasure Island, FL
    1. https://www.ncbi.nlm.nih.gov/books/NBK555971/

Images: Related links to external sites (from Bing)

Related Studies

Ontology: argatroban (C0048470)

Definition (NCI) A synthetic derivative of L-arginine with antithrombotic activity. Argatroban is a univalent and direct inhibitor of fibrin-bound thrombin. This agent reversibly binds to the thrombin active site thereby preventing the thrombin-dependent reactions, which include conversion of fibrinogen to fibrin; the activation of factors V, VIII and XI; the activation of protein C; and platelet aggregation. Argatroban is highly selective for thrombin and is able to inhibit the action of both free and clot-associated thrombin. As a result, stabilization of blood clots and coagulation is inhibited.
Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSH C031942
SnomedCT 116508003, 398738008
LNC LP94569-8, MTHU032477
English 2-Piperidinecarboxylic acid, 1-(5-((aminoiminomethyl)amino)-1-oxo-2-(((1,2,3,4-tetrahydro-3-methyl-8-quinolinyl)sulfonyl)amino)pentyl)-4-methyl-, 4-methyl-1-(N(2)-(3-methyl-1,2,3,4-tetrahydro-8-quinolinesulfonyl)-L-arginyl)-2-piperidinecarboxylic acid, MMTQAP, MPQA, 1-[5-guanidino-2-[(3-methyl-1,2,3,4-tetrahydroquinolin-8-yl)sulfonylamino]pentanoyl]-4-methyl-piperidine-2-carboxylic acid, ARGATROBAN, Argatroban (medication), argatroban [Chemical/Ingredient], Argatroban, Argatroban (product), Argatroban (substance), Argipidine, argatroban
Spanish argatrobano (sustancia), argatroban, argatroban (producto), argatrobán (producto), argatroban (sustancia), argatrobán, argatrobano

Ontology: Acova (C0939245)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C031942
English Acova, SmithKline Beecham brand of argatroban