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The direct thrombin inhibitor argatroban: a review of its use in patients with and without HIT

Authors Andreas Koster, Karl-Georg Fischer, Sebastian Harder, Fritz Mertzlufft

Published 15 November 2007 Volume 2007:1(2) Pages 105—112

Andreas Koster1, Karl-Georg Fischer2, Sebastian Harder3, Fritz Mertzlufft4

1Department of Anesthesia, Deutsches Herzzentrum Berlin, Germany; 2Department of Medicine, Division of Nephrology and General Medicine, Universitätsklinikum Freiburg, Germany; 3Pharmazentrum Frankfurt, Department of Clinical Pharmacology, Klinikum, J.W. Goethe-Universität Frankfurt/Main, Germany; 4Department of Anesthesia and Intensive Care Medicine, Evangelisches Krankenhaus, Campus Bethel, Bielefeld, Germany

Abstract: 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. Argatroban anticoagulation has been systematically studied in patients exhibiting the heparin-induced thrombocytopenia (HIT)/thrombosis syndrome and demonstrated to be a safe and effective therapy in this indication. Moreover, in smaller studies argatroban has also been assessed in special clinical settings in non-HIT patients. The current review presents the pharmacology of argatroban, data regarding monitoring of the agent, and an overview of the results of the major clinical trials assessing argatroban anticoagulation in HIT patients. Additionally, data from clinical trials with argatroban use outside HIT, in more special indications such as in percutaneous coronary intervention, stroke, renal replacement therapy, and intensive care medicine, are reviewed.
Keywords: anticoagulation, direct thrombin inhibitors, HIT

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