Argatroban

Administration

• Type: Anticoagulant (Direct thrombin inhibitor)
• Dosage Forms: injectable solution, ready-to-use injectable
• Dosage Strengths: injectable solution: 100mg/mL; ready-to-use injectable: 50mg/50mL 0.9% NaCl, 125mg/125mL 0.9% NaCl
• Routes of Administration: IV
• Common Trade Names: Acova

Adult Dosing

• HIT with thrombosis: 2 mcg/kg/min IV infusion, titrate to aPTT 1.5-3x baseline value
• Myocardial infarction: 100 mcg/kg IV bolus + 1-3mcg/kg/min IV infusion x 6-72 hours; goal aPTT 50-85 seconds
• Cerebral thrombosis: 60 mg/day continuous IV infusion x 2 days, then 10mg IV BID x 5 days
• Coronary thrombosis prophylaxis after PCI (in patients at risk for HIT): 350 mcg/kg IV bolus + 25 mcg/kg/min IV continuous infusion; titrate to maintain activated clotting time 300-450 seconds

Pediatric Dosing

Safety/efficacy not established

• HIT: 0.75 mcg/kg/min IV infusion; titrate in increments of 0.1-0.25 mcg/kg/min to goal aPTT 1.5-3x baseline level

Special Populations

• Pregnancy Rating: B
• Lactation risk: Infant risk cannot be ruled out
• Renal dosing: no adjustment
• Hepatic dosing: more frequent dosage adjustments may be needed. For HIT treatment in moderate-severe liver disease, initial dose 0.5mcg/kg/min

Contraindications

• Allergy to class/drug
• Major bleeding

Adverse Reactions

Serious

• Major bleeding: GI bleeding, retroperitoneal hemorrhage, intracranial hemorrhage, coronary artery hemorrhage, hematuria
• Angina, coronary artery thrombosis, aortic valve stenosis, MI, cardiac arrest
• Sepsis
• Pulmonary edema

Common

• Hypotension
• Chest pain
• Nausea/vomiting, diarrhea
• Headache, backache
• Dyspnea
• Fever

Pharmacology

• Half-life: 30-51min, prolonged in hepatic impairment
• Metabolism: Hepatic
• Excretion: Mostly fecal

Mechanism of Action

• Binds to and directly inhibits thrombin

See Also

• Coagulopathy (main)
• Anticoagulant reversal for life-threatening bleeds