Use:

• • Heparin allergy & Heparin intolerance (IE HIT)

  • Use it with caution in patients with liver dysfunction. Decrease the dose to half of the normal dosing.

  • No adverse effect on patients with renal dysfunction.

Before the Procedure:

1. Weight of patient: calculate bolus dose and infusion dose before the start of the procedure

2. Alaris pump & tubing

3. Argatroban 1:1 formulation, i.e. 50 mg in 50 mL vials per Pharmacy

4. Obtain baseline ACT. Argatroban affects ACT and aPTT similarly to heparin.

Dosing:

1. 1. 1. Range (the operator will determine the range: 230-250 is the typical range for IR procedures)

      2. Initial dose: 200 mcg/kg bolus

      3. Infusion: Begin at 1-2 mcg/kg/min if normal liver function; half the dose if abnormal

      4. Monitor ACT 5-10 minutes after the initial bolus and start of infusion; then monitor ACT every 30 minutes while Argatroban is infusing.

      5. ACT within range: continue infusion at the current rate (i.e. 2 mcg/kg/min if normal liver function).

      6. ACT low: increase rate by doubling infusion dose (i.e. 4 mcg/kg/min) and re-check ACT in 30 minutes.

      7. ACT high: decrease rate by cutting the dose in half (i.e. 1 mcg/kg/min) and re-check ACT in 30 minutes.

Bolus:

• • • The provider can order bolus in Epic.

    • It is not through the Argatroban infusion order set when an Argatroban infusion is not required.

    • There is a separate one-time order for a bolus from the Argatroban bottle.

    • Initial bolus: 250-350 mcg/kg x1 (per provider order). Frequent ACTs monitoring is required.

    • Additional bolus: 150 mcg/kg per additional dose.

References:

• • • Selleng S, Selleng K. Heparin-induced thrombocytopenia in cardiac surgery and critically ill patients. Thromb Haemost. 2016 Oct 28;116(5):843-851.

    • Babuin L, Pengo V. Argatroban in the management of heparin-induced thrombocytopenia. Vasc Health Risk Manag. 2010 Sep 7;6:813-9.

    • Martin ME, Kloecker GH, Laber DA. Argatroban for anticoagulation during cardiac surgery. Eur J Haematol. 2007 Feb;78(2):161-6.

    • Argatroban package insert. SmithKline Beecham. 2009.

    • MS Khaja, E. Mathes, WE Saad. Chapter 15- Hematologic Disorders. Patient Care in Vascular & Interventional Radiology. P. Waybill and D. Brown (Eds). Fairfax, VA; SIR 2017.