UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Argatroban in the ED patient

Keywords: argatroban, direct thrombin inhibitor, heparin, HIT (PubMed Search)

Posted: 6/6/2011 by Bryan Hayes, PharmD (Emailed: 7/2/2011) (Updated: 7/2/2011)
Click here to contact Bryan Hayes, PharmD

Patients requiring anticoagulation for HIT or with a history of HIT may be initiated on argatroban.  We have recently been seeing increased utilization.  Here are some important points to remember.

  • MOA: Direct thrombin inhibitor – reversibly binds to the active thrombin site of free and clot-associated thrombin
  • Monitoring parameters:
    • aPTT prior to starting therapy (similar to heparin)
    • aPTT two hours after initiation of therapy or after dose change
    • Signs/symptoms of bleeding, LFTs, CBC, Hgb/Hct
  • Dosing (general): 2 mcg/kg/min (actual body weight)
  • Important notes:
    • Discontinue all heparin products including hep locks and coated catheters.  This includes all LMWH such as enoxaparin.
    • Causes false elevation of INR by cross-reacting with the INR assay