title: Transition from argatroban to oral anticoagulation with phenprocoumon or acenocoumarol: effect on coagulation factor testing.
abstract: Treatment with the thrombin inhibitor argatroban is often followed by vitamin K-antagonist treatment. In this study, the behavior of coagulation factors measured under these treatment regimens is shown. Healthy subjects received infusions of 1.0, 2.0, or 3.0 microg/kg/hr argatroban before and during phenprocoumon or acenocoumarol dosing. Quantitation of factors II, VII, IX, and X by clot-based assays resulted in dose dependent, approximately 20%, lower than expected values in the presence of argatroban. On the contrary, values for the inhibitors, protein C and protein S, were higher. Cotherapy exaggerated the effect by vitamin K-antagonist alone. However, testing by immunologic and chromogenic assays did not show any effect by argatroban. Coupled with a lack of bleeding in the subjects, these data suggests that argatroban does not affect coagulation proteins and that the observations are only an assay artifact. Assay interferences must be considered when measuring coagulation proteins in patients receiving thrombin inhibitors.
authors.affiliation: Cardiovascular Institute, Loyola University Medical Center at Chicago, Maywood, IL 60153, USA. jwaleng@lumc.edu
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Walenga
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Drenth
authors.forename: Myttle
authors.initials: M
authors.lastname: Mayuga
authors.forename: Debra A
authors.initials: DA
authors.lastname: Hoppensteadt
authors.forename: Margaret
authors.initials: M
authors.lastname: Prechel
authors.forename: Sebastian
authors.initials: S
authors.lastname: Harder
authors.forename: Hikari
authors.initials: H
authors.lastname: Watanabe
authors.forename: Masanori
authors.initials: M
authors.lastname: Osakabe
authors.forename: Hans-Klaus
authors.initials: HK
authors.lastname: Breddin
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage*; D000284:Administration, Oral; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D001120:Arginine / Q000031:analogs & derivatives; D001779:Blood Coagulation Factors / Q000032:analysis*; D001780:Blood Coagulation Tests / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D019934:International Normalized Ratio; D008297:Male; D010644:Phenprocoumon / Q000008:administration & dosage*; D010875:Pipecolic Acids / Q000008:administration & dosage*; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D010875:Pipecolic Acids; D013449:Sulfonamides; D014812:Vitamin K; D001120:Arginine; D013917:Thrombin; D000074:Acenocoumarol; C031942:argatroban; D010644:Phenprocoumon