Name: ARGATROBAN
Classification:
  • selective thrombin inhibitor
    • reversibly inhibits the catalytic site of thrombin resulting in competitive inhibition of the enzyme and related biological activities
    • lacks antifibrinolytic activity; has no significant inhibitory effect on biosynthesis of vitamin K-dependent coagulant proteins
    • does not interact with heparin-induced antibodies
  • restricted to use by Hematology for heparin induced thrombocytopenia-thombosis syndrome
Dose:
  • Infusion Dose:
    • 2-10 mcg/kg/min; recommend start with 0.5 mcg/kg/min
    • titrate to aPTT 1.5-3 times baseline
    • moderate to severe hepatic dysfunction: initial dose of 0.5 mcg/kg/min; may have prolonged anticoagulation due to impaired elimination
    • onset of action 30 minutes, peak reponse within 2-3 hours, half life 30-50 minutes
Administration:

IV Infusion: 250 mg in 250 ml D5W or NS
Protect from light during storage and administration.
Slight haziness may appear upon preparation, but should rapidly disappear upon mixing.
Should be administered through a dedicated line.  

Adverse Effects:
  • bleeding
  • diarrhea, nausea/vomiting
  • elevation of serum transaminases
  • ventricular tachycardia, hypotension
Caution:

Use with caution in patients concomitantly receiving other anticoagulants or antiplatelet agents, or at increased risk of hemorrhage (eg. post major surgery or procedure, HTN)

 No known reversal agent available; if required, discontinue infusion and coagulation parameters should return to baseline within 2-4 hours.

CONVERSION TO WARFARIN THERAPY:
Do not give loading dose of warfarin; initiate therapy with expected daily dose of warfarin.
Agratroban dose up to 2 mcg/kg/min: discontinue argatroban infusion when INR >4.  Repeat INR measurement in 4 to 6 hours. If repeat INR is below the desired therapeutic range, resume argatroban infusion at previous rate and repeat the procedure daily until the desired therapeutic range on warfarin alone is reached.

Agratroban dose greater than 2 mcg/kg/min: once INR>4, reduce argatroban infusion to 2 mcg/kg/min.  Repeat the INR 4 to 6 hours after reduction of the argatroban dose and follow the process outlined above for administering argatroban at doses up to 2 mcg/kg/minutge  

Drug Interactions:
  • argatroban + warfarin  = increased INR greater than seen with warfarin alone
Monitoring Therapy:
  • PTT, INR, platelet count
  • bleeding
  • ECG, BP
  • Nausea
  • hepatic enzymes
CCTC Protocol:
  • May be administered by IV infusion by an approved RN in CCTC.
  • Must be administered as a continuous infusion by an infusion pump.
  • Should not be administered via the proximal injectate port (blue) of the Swan Ganz catheter.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: August 7, 2006

LHSCHealth Professionals

Last Updated July 20, 2011 | © 2007, LHSC, London Ontario Canada