II. Indications
- Heparin Induced Thrombocytopenia (HIT)
- Percutaneous Coronary Intervention (PCI) for patients at risk for HIT
III. Mechanism
- See Direct Thrombin Inhibitor
- Argatroban is a non-Hirudan (univalent agent)
IV. Dosing
-
Heparin Induced Thrombocytopenia (HIT)
- Initial: 2 mcg/kg/minute
- Initial lower dose indications
- Congestive Heart Failure or Anasarca
- Multiorgan failure
- Postcardiac surgery
- Maintenance: Adjusted per PTT
- PTT Target 1.5 to 3 fold over baseline
- PTT maximum <100 seconds
- Maximum: 10 mcg/kg/min
-
Percutaneous Coronary Intervention (PCI) for patients at risk for HIT
- Bolus 350 mcg/kg IV over 3 to 5 minutes
- Maintenance: 25 mcg/kg/min IV
- Target Activated Clotting Time (ACT) 300 to 450 sec throughout PCI procedure
- ACT <300 sec
- Bolus 150 mcg/kg IV
- Increase infusion to 30 mcg/kg/min
- ACT >450 sec
- Decrease infusion to 15 mcg/kg/min
- ACT <300 sec
V. Safety
- Unknown safety in pregnancy
- Contraindicated in Lactation
VI. Drug Interactions
-
Warfarin
- Argatroban prolongs INR
- INR > 4
- Discontinue Argatroban
- Recheck INR in 4 to 6 hours and restart Argatroban for subtherapeutic INR
VII. Resources
VIII. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Mahat (2022) Argatroban, StatPearls. Treasure Island, FL
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Related Studies
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 |