Alternative parenteral anticoagulation with argatroban, a direct thrombin inhibitor.
Argatroban, a direct thrombin inhibitor, effectively inhibits free and clot-bound thrombin without the need of a cofactor and exerts dose-dependent anticoagulant effects that are rapidly active and rapidly reversible (elimination half-life: 39-51 min). Argatroban provides predictable parenteral anticoagulation and is well tolerated with an acceptably low bleeding risk in a variety of clinical settings, including heparin-induced thrombocytopenia, acute ischemic stroke, percutaneous coronary intervention and hemodialysis. This review will discuss the clinical pharmacology and utility of argatroban; in particular, clinical trial experiences will be discussed in patients with, or at risk of, heparin-induced thrombocytopenia (where heparins must be avoided) including those requiring hemodialysis or percutaneous coronary intervention, and in patients with acute ischemic stroke (where heparins are not generally recommended).
LaMonte
Marian P
MP
University of Maryland School of Medicine, Baltimore, MD 21201-1595, USA. mlamonte@umm.edu
Brown
Philip M
PM
Hursting
Marcie J
MJ
D000925:Anticoagulants / Q000009:adverse effects; D001120:Arginine / Q000031:analogs & derivatives; D002545:Brain Ischemia / Q000150:complications; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D012307:Risk Factors; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors*; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy
D000925:Anticoagulants; D010875:Pipecolic Acids; D010975:Platelet Aggregation Inhibitors; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban