Generic Name:

Argatroban

Trade Name:

Argatroban

Action:

Direct Thrombin Inhibitor

Indication:

Therapeutic anticoagulation in patients with strongly suspected or confirmed Heparin Induced Thrombocytopenia (HIT type II).

Anticoagulation during and immediately following Percutaneous Coronary Interventions (PCI)

Coagulation studies should be known prior to starting therapy

HIT / HITTS

Bolus : none

Starting dose : 1 - 2 mcg/kg/min administered as a continuous infusion. Check aPTT 2 - 4 hours after the start of the infusion adjust dose accordingly.

Goal : aPTT 1.5 to 3x baseline. Do not exceed a PTT of 100

PCI (Cath Lab Only)

Bolus : 350 mcg/kg over 3 to 5 minutes

Maintenance infusion : 25 mcg/kg/min.

Check ACT in 5 to 10 minutes after the bolus.

Goal : ACT > 300 to < 450 sec

ACT < 300 sec : Give additional bolus of 150 mcg/kg and increase maintenance to 30 mcg/kg/min. Check ACT in 5 to 10 minutes after the bolus.

ACT > 450 sec : reduce maintenance to 15 mcg/kg/min. Recheck ACT in 5 to 10 minutes

PTT Goal (outside the cath lab)

Dosage Adjustments

(Based on previous rate)

If PTT < 39

Increase rate by 40%

If PTT 40 - 49

Increase rate by 20%

If PTT 50 - 70

No change

If PTT 71 - 84

Decrease rate by 20%

If PTT 85 - 99

Decrease rate by 40%

If PTT > 100

Hold, Call MD

The physician must write a new order for each dosage change

Hepatic Insufficiency

Argatroban is metabolized by the liver and should be used with caution in patients with significant liver dysfunction. If used institute dose at 20 to 25% of the normal starting dose. For patients with moderate hepatic impairment starting dose is 0.5mcg/kg/min and adjust accordingly.

Dosage in Renal Failure

Argatroban is mostly metabolism by non-renal mechanisms. Dosage adjustments may be required in patients with moderate to severe renal failure. Patients on CVVH should be monitored accordingly when there is an interruption or discontinuation of CVVH therapy

Standard Concentration

1 mg / ml

• 50 mg/50 ml Micro-infusion
• 100mg/100 mL
• 250mg/250ml

 EW Standards

•  100mg/ 100 mL

•  250mg /250 mL

Special Considerations

• Discontinue and remove all heparin products
• Obtain a baseline aPTT prior to initiating therapy
• ACT testing is available only in the Cath Lab
• Do not exceed 10mcg/kg/min (Except in CATH Lab)
• Once a stable dose is achieved draw aPTT every 24 hours.
• Obtain order for each change in dose
• There is no antidote or reversal agent for argatroban.
• INR and PT may also be elevated, but should not be considered monitoring parameters
• Administer via a dedicated line, argatroban is not compatible with other drugs

Precautions

Use with caution in patients with a recent history of:

Stroke, bleeding ulcers, severe uncontrolled hypertension, recent major surgery, and non-compressible large vessel punctures.

Dosage reductions may be required in the following circumstances:

• Recent use of thrombolytics and/or GP 2B-3A inhibitors
• Moderate to severe renal insufficiency and patients on CVVH
• Mild to moderate hepatic insufficiency
• Elderly patients

For conversion to warfarin therapy, overlap argatroban and warfarin for no less than 5 days.

• Start warfarin therapy at 5 mg per day
• On day 3-4, obtain a Chromogenic Xa (Special Coagulation Study)
• Chromogenic Xa level of 40% corresponds to an INR of 2
• Chromogenic Xa level of 20% corresponds to an INR of 3
• Chromogenic Xa should be therapeutic for 24 hours before discontinuing the argatroban.