title: Argatroban therapy does not generate antibodies that alter its anticoagulant activity in patients with heparin-induced thrombocytopenia.
abstract: Heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome that can lead to limb- and life-threatening thrombosis. Argatroban, a small synthetic molecule (Argatroban; GlaxoSmithKline, Philadelphia, PA), and lepirudin, a protein of non-human origin (Refludan; Aventis, Bridgewater, NJ), are direct thrombin inhibitors that have been used successfully for anticoagulant therapy in HIT patients. It has been reported that between 44-74% of lepirudin-treated HIT patients develop drug-specific antibodies that either enhance or suppress the anticoagulant activity of lepirudin. By contrast, there have been no reported patient experiences suggestive of unexpected loss or enhancement of argatroban's anticoagulant effect in clinical trials, including those in HIT patients, or in postmarketing safety surveillance of over 4,800 patients treated in Japan. To confirm the lack of antibodies in argatroban-treated patients with HIT, we examined plasma for anticoagulant-altering activity and reviewed dosing patterns of re-exposed patients. Paired, pre-therapy and post-therapy (> or =7 days) plasma pools exhibited comparable in vitro anticoagulant responses (aPTT and antithrombin activity) to argatroban supplementation. Argatroban at 5 microg/mL similarly prolonged aPTTs of normal plasma pretreated with IgG isolated from pre-therapy versus post-therapy plasma (P>0.6). In trials, mean argatroban doses during initial therapy versus re-exposure were not different among individuals anticoagulated for the treatment or prophylaxis of thrombosis (P=0.60) or during percutaneous coronary interventions (P=0.79), with no discernable pattern of suppression or enhancement of argatroban anticoagulation. Consistent with the lack of reported patient experiences suggestive of unexpected loss or enhancement of argatroban's anticoagulant effect across clinical trials and post-marketing safety surveillance, these data support the lack of anti-argatroban antibodies that affect drug activity in argatroban-treated HIT patients.
authors.affiliation: Cardiovascular Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA. jwaleng@lumc.edu
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Walenga
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Ahmad
authors.forename: Debra
authors.initials: D
authors.lastname: Hoppensteadt
authors.forename: Omer
authors.initials: O
authors.lastname: Iqbal
authors.forename: Marcie J
authors.initials: MJ
authors.lastname: Hursting
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Lewis
mesh_terms: D000906:Antibodies / Q000097:blood*; D000925:Anticoagulants / Q000008:administration & dosage* / Q000276:immunology / Q000494:pharmacology; D001120:Arginine / Q000031:analogs & derivatives; D004305:Dose-Response Relationship, Drug; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D010314:Partial Thromboplastin Time; D010875:Pipecolic Acids / Q000008:administration & dosage* / Q000276:immunology / Q000494:pharmacology; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D000906:Antibodies; D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban