- 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
- restricted to use by Hematology
for heparin induced thrombocytopenia-thombosis syndrome
Initial dose (by continuous infusion):
- 0.5 mcg/kg/min
- titrate to a PTT 1.5-3 times
baseline (PTT should not exceed 100 seconds)
- therapeutic levels usually achieved within 2.5 hours of starting therapy
- dose should not exceed 10 mcg/kg/min
Moderate to severe hepatic dysfunction:
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
250 mg in 250 ml dextrose 5%, sodium chloride 0.9% or Ringer's Lactate
- 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.
- diarrhea, nausea/vomiting
of serum transaminases
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
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
+ warfarin = increased
INR greater than seen with warfarin alone
- PTT (dose is titrated to achieve PTT 1.5 - 3 times normal)
- INR, hemoglobin, platelet count
(neurological assessment, gastrointestinal assessment, puncture site inspection)
- blood pressure
Patients with HIT undergoing percutaneous coronary intervention (PCI):
See Parenteral Drug Administration Manual
|Adult Critical Care Protocol:
- May be given by IV infusion by a nurse in Adult Critical Care.
- Continuous infusions must be administered by infusion device and the pump library must be enabled.