Clinical Experience of Argatroban in Germany

ABSTRACT

The main features of heparin-induced thrombocytopenia (HIT) are massive coagulation activation despite heparin anticoagulation and a drop in platelet count. A large proportion of patients with HIT develop thromboembolic complications if not treated with a nonheparin anticoagulant such as argatroban, danaparoid, or lepirudin. Whereas both lepirudin and danaparoid require dose adjustments or are contraindicated in patients with impaired renal function, argatroban can be used at normal therapeutic doses in these patients. Dose adjustments of argatroban are only necessary in patients with compromised liver function. Due to its short half-life, argatroban is an ideal anticoagulant for the perioperative phase. Argatroban typically is stopped 2 to 4 hours before surgery and restarted 2 to 12 hours after surgery. Argatroban is monitored by activated partial thromboplastin time test, but it also influences the prothrombin time test. When switching from argatroban to vitamin K antagonists, argatroban is discontinued when the international normalized ratio (INR) is > 4.0, and an additional INR is performed 4 hours after stopping argatroban. Other coagulation assays, including inhibitors (antithrombin, protein C, protein S), need to be interpreted with caution during argatroban therapy.

KEYWORDS

Heparin-induced thrombocytopenia - anticoagulants - argatroban - thrombin inhibitors

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