Argatroban

How it works

It directly and reversibly inhibits thrombin, preventing thrombin-mediated fibrin formation, platelet activation and amplification of the coagulation cascade.

Prescribing in practice

• It is metabolised hepatically, so reduce dose and use with particular caution in hepatic impairment to avoid excessive anticoagulation and bleeding.
• It prolongs the INR, which complicates transition to warfarin and requires a specific overlap and conversion approach.
• It is a key option for anticoagulation in heparin-induced thrombocytopenia where heparins must be avoided.

Monitoring

Titrate against the activated partial thromboplastin time and monitor closely, with extra care in hepatic impairment.

Counselling the patient

• This is an intravenous blood-thinning medicine used in hospital and adjusted to blood test results.
• Report any unusual bruising, bleeding or black stools.
• The team will manage any switch to oral anticoagulation carefully.

Evidence & guidelines

Argatroban is an established anticoagulant for the management of heparin-induced thrombocytopenia.