Does argatroban need monitoring?

Does argatroban need monitoring?

Argatroban or lepirudin anticoagulation therapy in patients with heparin induced thrombocytopenia (HIT) or HIT suspect is typically monitored using the activated partial thromboplastin time (aPTT).

How do you monitor argatroban?

Argatroban is monitored using the activated partial thromboplastin time (aPTT). The goal aPTT in seconds has been defined at UWMC/HMC as 60-80 seconds. Alternatively, it can be monitored with the direct thrombin inhibitor assay available at UWMC/HMC.

How is bivalirudin monitored?

At UWMC, bivalirudin is monitored using the Direct Thrombin Inhibitor (DTI) assay (Plasma-Diluted Thrombin Time). Used instead of aPTT to monitor injectable DTI therapy. Preferred over aPTT due to better sensitivity, and is not affected by antiphospholipid antibodies.

What is the indication for argatroban?

Argatroban Injection is indicated for prophylaxis or treatment of thrombosis in adult patients with heparin- induced thrombocytopenia (HIT). Argatroban Injection is indicated as an anticoagulant in adult patients with or at risk for HIT undergoing percutaneous coronary intervention (PCI).

Does argatroban affect PTT?

Monitoring of argatroban anticogulation An infusion of 2 μg/kg/min argatroban is expected to increase aPTT 1.5-fold, whereas an infusion of 10 μg/kg/min can prolong a PTT up to 3-fold.

What laboratory value can be falsely elevated with the use of argatroban?

Argatroban acted as an inhibitor in these assays, causing a dose-dependent false decrease of fibrinogen and factor levels, and a false increase of protein C.

What is the aPTT goal for bivalirudin?

Bivalirudin infusions were initiated at 0.05 to 0.3 mg/kg/hr. The aPTT goals were determined for each patient individually based on underlying disease and risk factors. The median time to achieve an aPTT level within the goal range was 4 hours, with a range of 1 to 25 hours.

Does bivalirudin affect aPTT?

In these 14 patients, the median change in INR at first therapeutic aPTT was 0.37 (range = 0.28-0.48; Figure 1), which occurred at a median of 8.4 hours (range = 4.6-14.2) after bivalirudin initiation.

Which is the most appropriate laboratory value to assess in the patient who is receiving argatroban?

For use in HIT, therapy with Argatroban Injection is monitored using the aPTT with a target range of 1.5 to 3 times the initial baseline value (not to exceed 100 seconds).

When to start argatroban after heparin infusion?

If patient was on Heparin infusion wait 3 hours prior to initiating Argatroban. If patient is on LMWH wait 8 hours except in the case that the patient has an active clot while on these medications. Obtain Hematology Consult to consider earlier initiation of Argatroban.

What is the infusion rate for argatroban for PTT?

1. Standard Argatroban Infusion is 250mg in Normal Saline 250mL, yielding a concentration of 1 mg/mL or 1000 mcg/mL. 2. Therapeutic Goal Range for PTT is 55-100. 3. Initial infusion rate: a. 0.5 mcg/kg/min for patients with CHF, mild hepatic insufficiency, and critical illness.

Is the adult argatroban drip protocol evidence based?

Adult Argatroban Drip Protocol This protocol reflects current evidence based clinical practice. It is not a substitute for appropriate clinical evaluation and does not supersede clinical judgment.

How is argatroban and bivalirudin removed from the body?

Both agents have a relatively short half-life in patients without organ system failure and are typically administered by continuous infusion. Argatroban is primarily eliminated by the liver, while bivalirudin is removed by a combination of proteolytic cleavage by thrombin and renal clearance mechanisms.