Argatroban Monohydrate

How it works

It reversibly inhibits the active site of both free and clot-bound thrombin, blocking fibrin generation, thrombin-mediated platelet aggregation and clotting-factor activation without needing antithrombin.

Prescribing in practice

• Because it is hepatically cleared, dose reduction is essential in hepatic impairment, and as there is no reversal agent, bleeding risk is managed by careful infusion titration.
• It elevates the INR, so conversion to an oral vitamin K antagonist follows a defined overlap protocol to prevent a gap in anticoagulation.
• Infusion rate is titrated against the APTT to a defined therapeutic target.

Monitoring

Use APTT to titrate the infusion, alongside platelet count, haemoglobin and clinical surveillance for bleeding, with dose moderation in liver disease.

Counselling the patient

• It is a continuous anticoagulant infusion managed in hospital.
• Tell staff promptly about any signs of bleeding or new bruising.
• Regular clotting tests guide adjustments to the infusion.

Evidence & guidelines

Direct thrombin inhibition with argatroban is supported by UK haematology guidance for the treatment of heparin-induced thrombocytopenia.