GFHT proposals on the practical use of argatroban — With specifics regarding vaccine-induced immune thrombotic thrombocytopaenia (VITT)

Acute pulmonary thromboembolism after messenger RNA vaccination against coronavirus disease 2019: A case report

“…In contrast, ex vivo and in vitro studies have shown that heparin, also argatroban, inhibited coagulation in cases of VITT [8] ; meta-analyses found no apparent difference in mortality between heparin and non-heparin anticoagulants against VITT [2] . Argatroban has been proposed as a non-heparin anticoagulant for VITT [9] .…”

Monitoring Argatroban Anticoagulation in the Critically Ill: All Tests Are Not Created Equal

“…As previously reported, the activated PTT has a variable correlation with DTIs and heparin. [3][4][5][6] In particular, the activated PTT is highly influenced by variations in the concentrations of the individual coagulation factors and those of the acute phase proteins. 1 Elevated concentrations of von Willebrand factor and fibrinogen are the main causes of the heparin resistance pattern in activated PTT monitoring.…”

“…The chromogenic ecarin anti-IIa assay and the diluted TT are the most commonly used calibrated reference tests for measuring argatroban concentrations in plasma. 6,9 Is there evidence that maintaining a target concentration of an anticoagulant leads to better clinical outcomes than maintaining a target prolongation of a coagulation test such as the activated PTT? A recent meta-analysis reported activated PTT-based heparin management was comparable to heparin concentration-based management using a chromogenic anti-Xa assay.…”

“…11 In contrast, the French Perioperative Hemostasis Group provides a nuanced evaluation of current assays for monitoring argatroban and recommends monitoring argatroban with a calibrated anti-IIa assay targeting a concentration between 0.5 and 1.5 µg/ml, a technique not commonly used in the United States. 6 Given the paucity of available data, deciding which recommendation to follow is difficult. However, as noted by the authors, argatroban concentrations in patients with a doubled baseline activated PTT can result in an approximately fourfold difference in concentrations (0.4 g/ml vs. 1.62 µg/ml), depending on the activated PTT reagent and individual patient conditions.…”

“…8 The chromogenic ecarin anti-IIa assay, like the anti-Xa assay for heparin concentration monitoring, is a photometric assay performed in plasma. 6 It utilizes a prothrombin buffer in the assay to ensure adequate prothrombin concentrations without diluting the sample with plasma before measurement. 6 However, this automated test system utilizes reflex testing, meaning that automatic dilution of the sample occurs when drug concentrations are above the calibration point.…”