Transition from argatroban to oral anticoagulation with phenprocoumon or acenocoumarol: effect on coagulation factor testing.
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.
Walenga
Jeanine M
JM
Cardiovascular Institute, Loyola University Medical Center at Chicago, Maywood, IL 60153, USA. jwaleng@lumc.edu
Drenth
Amanda F
AF
Mayuga
Myttle
M
Hoppensteadt
Debra A
DA
Prechel
Margaret
M
Harder
Sebastian
S
Watanabe
Hikari
H
Osakabe
Masanori
M
Breddin
Hans-Klaus
HK
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
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D010875:Pipecolic Acids; D013449:Sulfonamides; D014812:Vitamin K; D001120:Arginine; D013917:Thrombin; D000074:Acenocoumarol; C031942:argatroban; D010644:Phenprocoumon