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Switching to warfarin : Argatroban interferes with the INR assay; stopping this drug too
Rivaroxaban versus warfarin in non-valvular atrial fibrillation (ROCKET-AF)
If the
- Advantages and disadvantages of oral anticoagulants - LMW heparin dosing renal insufficiency (adults) - Anticoagulant dose adjustment in liver disease - Possible contraindications to anticoagulation - Standard dosing of DOACs - DOACs PK and drug interactions - Inhibitors and inducers of P-glycoprotein drug efflux - DOAC absorption
Initiate an infusion of Argatroban Injection at 25 mcg/kg/min and administer a bolus of 350 mcg/kg via a large bore intravenous line over 3 to 5 minutes (see Table 2 )
Bridging anticoagulation during warfarin interruption ANTICOAGULANTS - PARENTERAL Argatroban 40-50 min Hepatic impairment: ≤181 min Hold 2-3 hours until PTT < 40 Hold longer in hepatic impairment, until PTT <40 Treatment: Low risk bleeding*: resume 24hrs post-procedure (Lovenox High risk bleeding*: resume 48- Visio-clin-management-heparin-it-web-algorithm
Argatroban is a synthetic direct thrombin inhibitor with a relative short elimination half-life of 45 minutes and elimination which is predominantly performed via hepatic metabolism
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Dabigatran is given as an oral pro-drug dabigatran etexilate
An algorithm for monitoring and adjustment of maintenance The manufacturer has recommendations for bridging with argatroban to warfarin
The largest study of argatroban use in HIT, where 418 patients were treated and 63% were transitioned to warfarin, did not define the transition protocol or guideline used
Each mL of sterile, nonpyrogenic solution contains 100 mg Argatroban
The half-life may extend to ~3 hours in patients with hepatic dysfunction
We report a prospective, historical- controlled study evaluating the efficacy and safety of argatroban, a direct thrombin inhibitor, as anticoagulant therapy in patients with HIT or HIT with thrombosis syndrome (HITTS)
Wait 3 hours after discontinuation of heparin infusion to start ar gatroban infusion
Setting: Academic medical center and community-based teaching hospital
Patient Anticoagulation with Initial Cannulation (Argatroban therapy is to be started 30 minutes prior to initiation of ECMO): Appropriate standard direct oral anticoagulant dosing in patients with a BMI ≥ 40 kg per m 2 or weight ≥ 120 kg