argatroban

argatroban /ar·gat·ro·ban/ (ahr-gat´ro-ban?) an anticoagulant used in the prophylaxis and treatment of heparin-induced thrombocytopenia.

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argatroban Warning - High-alert drug!

Acova

Pharmacologic class: L-arginine-derived thrombin inhibitor

Therapeutic class: Anticoagulant

Pregnancy risk category B

Action

Binds rapidly to site of thrombi, neutralizing conversion of fibrinogen to fibrin, activation of coagulation factors, and platelet aggregation (processes required for thrombus formation)

Availability

Injection: 100 mg/ml in 2.5-ml vials

⊘Indications and dosages

➣ Treatment or prophylaxis of thrombosis in patients with heparin-induced thrombocytopenia

Adults: 2 mcg/kg/minute as a continuous I.V. infusion, to a maximum dosage of 10 mcg/kg/minute. Adjust dosage as needed to maintain activated partial thromboplastin time (APTT) at 1.5 to 3 times initial baseline value (not to exceed 100 seconds).

➣ Anticoagulation during percutaneous coronary intervention in patients who have or are at risk for heparin-induced thrombocytopenia

Adults: Start continuous I.V. infusion at 25 mcg/kg/minute and give loading dose of 350 mcg/kg by I.V. bolus over 3 to 5 minutes. Check activated clotting time (ACT) 5 to 10 minutes after bolus dose is given; adjust dosage until ACT is between 300 and 450 seconds. If ACT is below 300 seconds, give additional I.V. bolus dose of 150 mcg/kg; then increase infusion rate to 30 mcg/kg/minute, and check ACT after 5 to 10 minutes. If ACT exceeds 450 seconds, decrease infusion rate to 15 mcg/kg/minute, and check ACT after 5 to 10 minutes. Maintain adjusted infusion dosage once therapeutic ACT has been reached.

Dosage adjustment

• Hepatic impairment

Contraindications

• Hypersensitivity to drug
• Overt major bleeding

Precautions

Use cautiously in:
• hepatic impairment or disease, intracranial bleeding
• pregnant or breastfeeding patients
• children younger than age 18.

Administration

• Stop all parenteral anticoagulants before starting argatroban.
• Dilute in normal saline solution, dextrose 5% in water, or lactated Ringer's solution to a concentration of 1 mg/ml.
• Inject contents of 2.5-ml vial into 250-ml bag of diluent.
• Protect solution from direct sunlight.

Route	Onset	Peak	Duration
I.V.	Rapid	1-3 hr	Duration of infusion

Adverse reactions

CNS: headache

CV: hypotension, unstable angina, atrial fibrillation, cardiac arrest, ventricular tachycardia, cerebrovascular disorders

GI: nausea, vomiting, diarrhea, abdominal pain, anorexia, GI bleeding

GU: urinary tract infection, minor GU tract bleeding and hematuria, renal dysfunction

Hematologic: groin bleeding, brachial bleeding, hypoprothrombinemia, thrombocytopenia, bleeding or hemorrhage

Respiratory: cough, dyspnea, pneumonia, hemoptysis

Skin: rash, bleeding at puncture site

Other: allergic reaction, pain, infection, fever, sepsis, anaphylaxis

Interactions

Drug-drug. Oral anticoagulants: prolonged prothrombin time, increased International Normalized Ratio, increased risk of bleeding

Thrombolytics: increased risk of intracranial bleeding

Drug-diagnostic tests. Hematocrit, hemoglobin: decreased values

Patient monitoring

☞ Monitor patient for signs and symptoms of anaphylaxis.
☞ Evaluate patient for bleeding tendency and hemorrhage.
• Assess neurologic status and vital signs frequently.
• Monitor CBC and coagulation studies, especially partial thromboplastin time.
☞ Check for signs and symptoms of serious arrhythmias and hypotension.

Patient teaching

☞ Instruct patient to immediately report allergic reaction and unusual bleeding or bruising.
• Tell patient to avoid activities that can cause injury. Advise him to use a soft toothbrush and electric razor to avoid gum and skin injury.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Tell patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.