Anticoagulant Therapy-Argatroban Mechanism of Action

•	Argatroban is a direct thrombin inhibitor that reversibly binds to the thrombin active site.
•	Argatroban does not require the cofactor antithrombin III for antithrombotic activity.
•	Argatroban exerts its anticoagulant effects by inhibiting thrombin-catalyzed or thrombin-induced reactions, including fibrin formation and activation of coagulation factors V, VIII, and XIII (see Figure 1).
•	Argatroban also inhibits the effect of thrombin on protein C activation and platelet aggregation.[2]

Figure 1. Argatroban Inhibits Thrombin-Catalyzed or
Thrombin-Induced Reaction in Coagulation[2,7]

Indications
Argatroban is indicated as an anticoagulant for prophylaxis or treatment of thrombosis in patients with heparin-induced thrombocytopenia.

Argatroban is indicated as an anticoagulant in patients with or at risk for heparin-induced thrombocytopenia undergoing percutaneous coronary intervention (PCI).

Important Safety Information

As with all anticoagulants, bleeding is a serious concern. Argatroban is contraindicated in patients with overt major bleeding or those with hypersensitivity to the product or any of its components. Argatroban should be used with extreme caution in disease states or other circumstances in which there is an increased risk of hemorrhage. Overall major bleeding was reported in 5.3% of patients with HIT treated with Argatroban versus 6.7% of the historical controls. Overall major bleeding was reported in 1.8% of patients undergoing PCI treated with Argatroban versus 3.1% of the historical controls. Intracranial bleeding was not observed in the 568 patients treated with Argatroban for HIT (with or without thrombosis) or in the 91 patients who underwent PCI. The most common nonhemorrhagic side effects in HIT patients, regardless of the relationship to treatment, were dyspnea, hypotension, and fever. In patients undergoing PCI, the nonhemorrhagic side effects, regardless of the relationship to treatment, included chest pain, hypotension, and back pain. Please see full Prescribing Information for additional safety information on Argatroban.