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