Generic Name

Argatroban

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Classification

FDA Approved Indications

• Prophylaxis or treatment of thrombosis in patients with heparin-induced thrombocytopenia (HIT)

Mechanism of Action

Argatroban reversibly binds to the active site of thrombin, directly inhibiting its activity and thereby preventing fibrin formation, activation of coagulation factors V and XIII, and platelet aggregation.

Dosage and Administration

Adult: Initial infusion rate of 2 mcg/kg/min, titrated to achieve target activated partial thromboplastin time (aPTT) 1.5 to 3 times baseline; usual max dose 10 mcg/kg/min.

Pediatric: Not FDA approved, limited data; use with caution and under specialist guidance.

Geriatric: Lower initial doses may be considered due to increased bleeding risk; close monitoring recommended.

Renal Impairment: Adjust dosing based on renal function; no specific dose adjustment, but caution advised.

Hepatic Impairment: No specific dose adjustment; monitor bleeding closely.

Pharmacokinetics

Absorption: Not applicable (administered IV).

Distribution: Moderate volume of distribution (~174 mL/kg).

Metabolism: Hepatic metabolism via CYP3A4/5 enzymes.

Excretion: Primarily hepatic; minimal renal elimination.

Half Life: Approximately 40 minutes in healthy subjects; may be prolonged in hepatic impairment.

Contraindications

• Active major bleeding
• Known hypersensitivity to Argatroban

Precautions

• Hepatic impairment (dose adjustment may be necessary)
• Use with caution in patients at high bleeding risk
• Monitor hepatic function regularly

Adverse Reactions - Common

• Bleeding (Very common)
• Back pain (Common)
• Elevated liver enzymes (Common)

Adverse Reactions - Serious

• Major bleeding (e.g., intracranial, GI hemorrhage) (Serious/rare)
• Hypersensitivity reactions (Rare)

Drug-Drug Interactions

• Other anticoagulants (increased bleeding risk)
• Antiplatelet agents

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report signs of bleeding immediately
• Do not discontinue without medical advice
• Inform healthcare providers of Argatroban use prior to any procedures

Special Considerations

Black Box Warnings:

• Excessive bleeding risk

Genetic Factors: No specific genetic markers required for dosing.

Lab Test Interference: May affect coagulation tests, including aPTT, INR.

Overdose Management

Signs/Symptoms: Severe bleeding, hypotension, shock.

Treatment: Discontinue Argatroban; provide supportive measures, including blood products; use of idarucizumab is not indicated as it's not a reversal agent for Argatroban.

Storage and Handling

Storage: Store at room temperature 20-25°C (68-77°F); protect from light.

Stability: Stable for the duration of infusion; discard if solution is discolored or contains particulate matter.