argatroban
Brand: Acova
ISMP High Alert Prototype: bivalirudin
Drug Class: anticoagulant
Drug Family: anticoagulant
Subclass: direct thrombin inhibitor (small molecule)
Organ Systems: cardiovascular
Mechanism of Action
Univalent DTI; hepatic clearance preferred in renal failure; falsely elevates INR during warfarin transition.
thrombin active site
Indications
- HIT type II management
- PCI in HIT patients
Contraindications
- active major bleeding
- severe hepatic impairment
Adverse Effects
Common
- bleeding
- hypotension
Serious
- major hemorrhage
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | moderate |
| Metabolism | extensive hepatic CYP3A4/5 |
| Excretion | biliary/fecal |
| Half-life | 39-51 min |
| Onset | immediate |
| Peak | immediate |
| Duration | 1 hour |
| Protein Binding | 54% |
| Vd | 0.18 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| warfarin | falsely elevates INR during transition — use chromogenic factor X assay | major |
Nursing Considerations
- HIT: target aPTT 1.5-3x baseline (60-100 sec)
- Hepatic dosing: reduce in hepatic impairment (NOT renal)
- INR transition: INR >4 on argatroban alone indicates therapeutic warfarin; stop argatroban 4-6h later and recheck
- NOT reversed by protamine
Clinical Pearls
- Hepatic clearance: preferred in renal failure
- Falsely elevates INR: chromogenic factor X assay used to monitor warfarin during transition
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.