Argatroban (Argatra®)

Biochemistry

Argatroban (Argatra ^® ) is a reversible, monovalent direct thrombin inhibitor available only as an infusion solution.

Clinical significance

Argatroban is approved to continue anticoagulation in adults with type II heparin-induced thrombocytopenia (HIT).
The elimination of argatroban and its metabolites occurs mainly via the liver (65.4 ± 7.1%) less than the kidney (21.8 ± 5.8%). Thus, argatroban does not accumulate in cases of renal insufficiency. There is no antidote.

Indication

• Monitoring of anticoagulation using Argatra, while using a heart-lung machine or during percutaneous coronary intervention (PCI). With the doses of more than 1 µg/ml argatroban, which are usual on the heart-lung machine or in PCI, the argatroban concentration/aPTT-time curve shows an asymptotic course, not a linear course.
• Measuring the coagulation inhibition in connection with argatroban can be useful in order to avoid excessive high exposure to argatroban if additional risk factors are present.

Literature

1. Sedhai YR, Mahat KC, Krishnan P. Argatroban. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.
2. Bachler M, Hell T, Bösch J, Treml B, Schenk B, Treichl B, Friesenecker B, Lorenz I, Stengg D, Hruby S, Wallner B, Oswald E,
3. Ströhle M, Niederwanger C, Irsara C, Fries D. A Prospective Pilot Trial to Assess the Efficacy of Argatroban (Argatra®) in Critically Ill Patients with Heparin Resistance. J Clin Med. 2020 Mar 31;9(4)
4. Dingman JS, Smith ZR, Coba VE, Peters MA, To L. Argatroban dosing requirements in extracorporeal life support and other critically ill populations. Thromb Res. 2020 May;189:69-76.
5. Evaluation of intravenous direct thrombin inhibitor monitoring tests: Correlation with plasma concentrations and clinical outcomes in hospitalized patients. Beyer JT, Lind SE, Fisher S, Trujillo TC, Wempe MF, Kiser TH. J Thromb Thrombolysis. 2020 Feb;49(2):259-267