Intravenous Treatment and prophylaxis of thrombosis in patients with heparin-induced thrombocytopenia
Adult: Initially, 2 mcg/kg/min by continuous infusion. Check aPTT after 2 hr and adjust dose until steady-state aPTT is 1.5-3 times the initial baseline value, not exceeding 100 seconds. Max: 10 mcg/kg/min. Patients who has undergone cardiac surgery, critically ill patients/intensive care unit patients w/ multiple organ failure: Initially, 0.5 mcg/kg/min, then adjust to the target aPTT range.
Intravenous Anticoagulant in percutaneous coronary intervention
Adult: Initially, 25 mcg/kg/min by infusion and 350 mcg/kg by bolus inj given simultaneously over 3-5 min. Check activated clotting time (ACT) 5-10 min after the bolus dose is completed, procedure may proceed if ACT is >300 seconds; if ACT is <300 seconds, an additional bolus dose of 150 mcg/kg may be given, adjust infusion rate to 15-40 mcg/kg/min then check ACT after 5-10 min.
Treatment and prophylaxis of thrombosis in patients w/ heparin-induced thrombocytopenia:
Moderate: Initially, 0.5 mcg/kg/min. Severe: Contraindicated.
Dilute in NaCl 0.9%, dextrose 5% or lactated Ringer’s inj to a final concentration of 1 mg/mL.
Incompatible w/ amiodarone.
Active major bleeding. Severe hepatic impairment.
Disease states and other circumstances in which there is an increased risk of haemorrhage (e.g. severe HTN, major surgery). Critically ill patients. Moderate hepatic impairment. Childn. Pregnancy and lactation.
Haemorrhagic effects (e.g. GI bleeding, haematuria, hemoptysis), hypotension, fever, dyspnoea, diarrhoea, sepsis, nausea, cardiac arrest, ventricular tachycardia, pain, UTI, vomiting, infection, pneumonia, AF, cough, abnormal renal function, abdominal pain, cerebrovascular disorder, chest and back pain, headache, MI, bradycardia.
Monitor Hb, haematocrit, signs/symptoms of bleeding; aPTT, ACT.
Symptoms: Excessive anticoagulation w/ or w/o bleeding. Management: Symptomatic and supportive treatment.
Increased risk of bleeding w/ antiplatelet agents, thrombolytics and other anticoagulants. Increased INR and prothrombin time w/ warfarin.
Description: Argatroban is a synthetic direct thrombin inhibitor which reversibly binds to the active thrombin site of free and clot-associated thrombin. It exerts its anticoagulant effects by inhibiting thrombin-catalysed or -induced reactions, e.g. fibrin formation; activation of coagulation factors V, VIII, and XIII; activation of protein C; and platelet aggregation. Onset: Immediate. Pharmacokinetics: Absorption: Time to peak plasma concentration: Steady-state: 1-3 hr. Distribution: Distributed mainly in the extra-cellular fluid. Volume of distribution: 174 mL/kg. Plasma protein binding: 20% (albumin); 34% (α1-acid glycoprotein). Metabolism: Undergoes hepatic metabolism mainly via hydroxylation and aromatisation; also metabolised by CYP3A4/5 isoenzymes to form 4 known metabolites. Excretion: Primarily in the faeces via the bile, as metabolites and at least 14% as unchanged drug; via urine (approx 16% as unchanged drug). Terminal elimination half-life: 39-51 min.
Store between 20-25°C. Do not freeze. Protect from light.
B01AE03 - argatroban ; Belongs to the class of direct thrombin inhibitors. Used in the treatment of thrombosis.
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