Argatroban

How it works

It binds directly and reversibly to the active site of thrombin, inhibiting thrombin-catalysed reactions including fibrin formation and platelet activation, independently of antithrombin.

Prescribing in practice

• Bleeding is the main hazard and there is no specific antidote, so it is given by infusion with careful titration, particularly because hepatic impairment markedly reduces clearance and necessitates dose reduction.
• It prolongs the INR, which complicates transition to warfarin and requires a specific overlapping protocol to avoid under-anticoagulation.
• Dosing is guided by the activated partial thromboplastin time (APTT) and adjusted to a target therapeutic range.

Monitoring

Monitor APTT to guide infusion rate, together with full blood count and signs of bleeding, with extra caution in hepatic dysfunction.

Counselling the patient

• This is an intravenous anticoagulant given and monitored in hospital.
• Report any bleeding, bruising or dark stools to the team straight away.
• Frequent blood tests are needed to keep the dose in the right range.

Evidence & guidelines

Argatroban is an established option for anticoagulation in heparin-induced thrombocytopenia, as reflected in UK haematology guidance.