Direct Thrombin Inhibitor — HIT Pregnancy: Use only if clearly necessary — limited data

Argatroban

Brand names: Exembol, Argatra

Adult dose

Dose: HIT: 2 micrograms/kg/min IV infusion (initial); adjust to aPTT 1.5–3× baseline (max 100 seconds)

Route: Intravenous continuous infusion

Frequency: Continuous

Max: 10 micrograms/kg/min (except hepatic impairment — use lower dose)

Reduce initial dose to 0.5 micrograms/kg/min in hepatic impairment (Child-Pugh B/C) — hepatically cleared. Check aPTT 2 hours after starting or changing dose. Transition to warfarin: continue argatroban until INR >4 on combined therapy, then stop argatroban and recheck INR after 4–6 hours.

Paediatric dose

Route:

Seek specialist opinion — used in paediatric HIT under specialist haematology guidance

Dose adjustments

Renal

No dose adjustment required — hepatically metabolised (advantage over bivalirudin in renal failure)

Hepatic

Reduce dose to 0.5 micrograms/kg/min in hepatic impairment (Child-Pugh B/C); monitor closely

Clinical pearls

HIT choice algorithm: renal failure → argatroban (hepatic clearance); hepatic failure → bivalirudin (enzymatic clearance)
Argatroban elevates the PT/INR — transitioning to warfarin requires INR >4 before stopping argatroban; recheck true INR 4–6 hours after stopping
Monitor aPTT — target 1.5–3× baseline; check 2 hours after each rate change
No antidote — bleeding managed by stopping infusion; half-life 39–51 minutes
Licensed in the UK for HIT (Exembol) — argatroban for thrombosis in HIT (HITT) and for prophylaxis

Contraindications

Active major bleeding
Hypersensitivity to argatroban

Side effects

Bleeding
Hypotension
Fever
Nausea
Diarrhoea
Sepsis (in critically ill)
Elevated LFTs

Interactions

Anticoagulants — additive bleeding
Thrombolytics — additive bleeding
Antiplatelets — additive bleeding
Warfarin: argatroban elevates INR — complex overlap management required

Monitoring

aPTT every 2 hours until stable, then every 4–6 hours
INR (for warfarin transition)
LFTs
FBC
Renal function
Signs of bleeding

Reference: BNFc; BNF 90; MHRA Argatroban SPC; ARG-911/ARG-915 HIT Trials; ASH HIT Guidelines 2018. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Argatroban · Direct Thrombin Inhibitor — HIT

Pathways