argatroban


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argatroban

 [ahr-gat´ro-ban″]
an anticoagulant that binds to the thrombin active site and inhibits various thrombin-catalyzed reactions; used in the prophylaxis and treatment of thrombocytopenia resulting from treatment with heparin, administered intravenously.

argatroban

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.

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.

argatroban

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

argatroban

[ahr-gat′ro-ban′]
an anticoagulant that binds to the thrombin active site and inhibits various thrombin-catalyzed reactions. It is used in the prophylaxis and treatment of thrombocytopenia resulting from treatment with heparin; administered intravenously.

argatroban

A recombinant, direct thrombin-inhibitor-type anticoagulant used to manage heparin-induced thrombocytopaenia (HIT), heparin-induced thrombocytopaenia and thrombosis syndrome (HITTS) and for patients with or at risk for HIT undergoing percutaneous coronary intervention. It may be used with thrombolytics (e.g., tPA and streptokinase) in managing acute MI.

argatroban

Novastan® Hematology An anticoagulant used to treat Pts with heparin-induced thrombocytopenia–HIT, heparin-induced thrombocytopenia & thrombosis syndrome–HITTS, which may be used with thrombolytics–eg, tPA and streptokinase in managing acute MI
References in periodicals archive ?
2) This can be accomplished by prompt discontinuation of all sources of heparin, including heparin lock flush IV solutions, and initiating treatment with a DTI such as argatroban.
Lepirudin (50 mg; Refludan, Celgene Europe Ltd, Wndsor, United Kingdom) and argatroban (250 mg/2.
Teva Receives FDA's Tentative Approval for Argatroban II-60
Argatroban: Argatroban is an L-arginine derivative that binds to the active site of free, fibrin-bound, and clot-associated thrombin,8 thereby preventing fibrin formation, Factor V, VIII, and XIII activation, protein C activation, and platelet aggregation.
HIT tedavisinde secilebilecek antikoagulanlar; bir heparinoid olan danaparoid, geri donusumsuz direk trombin inhibitoru rekombinant hirudin olan lepirudin, geri donu sumlu direk trombin inhibitorleri bivalirudin, argatroban ve fondaparinuxtur [6].
The patient was instructed to draw up argatroban and then dilute the medication into the 30 mL syringe containing 28.
P450 isoenzymes render many medications, including argatroban, more water-soluble for renal excretion (RxList Inc.
The direct thrombin inhibitors (DTIs) lepirudin and argatroban are used to achieve effective anticoagulation in patients with heparin-induced thrombocytopenia with or without thrombosis (type II) (8-10).
Placental transfer of argatroban (Acova) to the fetus probably occurs because of its relatively low molecular weight (527 d) and protein-binding capacity.
Additional studies are underway to support the use of Argatroban in ischemic stroke, angioplasty and hemodialysis.
Its pharmaceutical business division provides active pharmaceutical ingredients and pharmaceutical intermediates ranging from zaltoprofen and flurbiprofen to argatroban and voglibose.
Q Our pharmacy has started running partial thromboplastin time (PTT) tests on patients on a drug called argatroban.