The information contained herein is applicable to patients receiving argatroban in the setting of heparin induced thrombocytopenia. If argatroban is being utilized in other settings, including percutaneous coronary interventions, it is suggested that the Hematology Consultation service (pager: 443-4276) and a physician in the coagulation laboratory (353-1747) be contacted.
Argatroban is usually monitored by the activated PTT. Rarely, however, plasma argatroban levels should be measured to give a more accurate estimate of clinical anticoagulation.
Lupus anticoagulants can prolong the PTT at baseline, or impact the PTT after a patient has begun heparin therapy. If a patient being treated with argatroban is known or suspected to have a lupus anticoagulant, an argatroban level and an aPTT should be sent simultaneously. If review of results of simultaneous argatroban and PTT measurements indicates that the patient's lupus anticoagulant is causing an artifactual PTT prolongation, subsequent monitoring with argatroban levels is indicated.
The manufacturer of argatroban, GlaxoSmithKline, provides complete prescribing information on its website: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020883s014lbl.pdf, including information on the association of plasma argatroban levels and the activated PTT. A portion of the relevant information from this March 2009 document is summarized in the following information:
"Laboratory Tests: Anticoagulation effects associated with Argatroban infusion at doses up to 40 mcg/kg/min correlate with increases of the activated partial thromboplastin time (aPTT)."
"Dosage Adjustment: After the initial dose of Argatroban, the dose can be adjusted as clinically indicated (not to exceed 10 mcg/kg/min), until the steady-state aPTT is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds)"
Patients for whom a lupus anticoagulant influences the PTT must be monitored with argatroban levels. Therapeutic levels are not recommended by the manufacturer, but the manufacturer does provide a graph that shows a relationship among representative PTT levels, ACT levels, infusion rates, and plasma Argatroban levels:
In Figure 1.Relationship at Steady State Between Argatroban Dose, Plasma Argatroban Concentration and Anticoagulant Effect: A 0.4 microgram/mL argatroban level corresponded to approximately 1.6x the baseline PTT whereas a 2.0 microgram/mL argatroban level corresponded to approximately 2.6x the baseline PTT.
At UCSF we have assessed the sensitivity of our current PTT reagent to argatroban in May 2020. In plasma calibrators containing argatroban, we observed that 0.56 microgram/mL argatroban resulted in a PTT 1.8x baseline, 1.08 microgram/mL resulted in a PTT 2.2x baseline, 1.58 microgram/mL resulted in a PTT 2.5x baseline, and 2.07 microgram/mL resulted in a PTT 2.8x baseline. These results are generally similar to the information provided by the manufacturer and to the results of prior UCSF ex vivo spiking studies (performed in 2006, 2009, 2013, 2019).
On the basis of the information available, argatroban levels of 0.5-2.0 micrograms/mL can be considered therapeutic. These levels corresponded to 1.6x-2.7x baseline PTT in plasma without a lupus anticoagulant, which is within the manufacturer's recommended therapeutic PTT of 1.5x-3.0x patient baseline.
For adult patients without lupus anticoagulants an argatroban order form is available and should be utilized. The therapeutic PTT as of August 2017 was 52-67.9 seconds. For patients in whom the PTT cannot be used for monitoring, a derivative algorithm, based on a therapeutic target of 0.5-2.0 micrograms/mL, should be used for monitoring and dose adjustment, as clinically indicated. It is suggested that the Hematology Consultation service (415-443-4276) be contacted for recommendations regarding an appropriate algorithm for monitoring and dose adjustment in these patients.
The presence of heparin will interfere with the argatroban assay and can produce an erroneously elevated argatroban test result.
The information contained herein is applicable to patients receiving argatroban in the setting of heparin induced thrombocytopenia. If argatroban is being utilized in other settings, including percutaneous coronary interventions, it is suggested that the Hematology Consultation service (pager: 443-4276) and a physician in the coagulation laboratory (353-1747) be contacted.
Argatroban is usually monitored by the activated PTT. Rarely, however, plasma argatroban levels should be measured to give a more accurate estimate of clinical anticoagulation.
Lupus anticoagulants can prolong the PTT at baseline, or impact the PTT after a patient has begun heparin therapy. If a patient being treated with argatroban is known or suspected to have a lupus anticoagulant, an argatroban level and an aPTT should be sent simultaneously. If review of results of simultaneous argatroban and PTT measurements indicates that the patient's lupus anticoagulant is causing an artifactual PTT prolongation, subsequent monitoring with argatroban levels is indicated.
The manufacturer of argatroban, GlaxoSmithKline, provides complete prescribing information on its website: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020883s014lbl.pdf, including information on the association of plasma argatroban levels and the activated PTT. A portion of the relevant information from this March 2009 document is summarized in the following information:
"Laboratory Tests: Anticoagulation effects associated with Argatroban infusion at doses up to 40 mcg/kg/min correlate with increases of the activated partial thromboplastin time (aPTT)."
"Dosage Adjustment: After the initial dose of Argatroban, the dose can be adjusted as clinically indicated (not to exceed 10 mcg/kg/min), until the steady-state aPTT is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds)"
Patients for whom a lupus anticoagulant influences the PTT must be monitored with argatroban levels. Therapeutic levels are not recommended by the manufacturer, but the manufacturer does provide a graph that shows a relationship among representative PTT levels, ACT levels, infusion rates, and plasma Argatroban levels:
In Figure 1.Relationship at Steady State Between Argatroban Dose, Plasma Argatroban Concentration and Anticoagulant Effect: A 0.4 microgram/mL argatroban level corresponded to approximately 1.6x the baseline PTT whereas a 2.0 microgram/mL argatroban level corresponded to approximately 2.6x the baseline PTT.
At UCSF we have assessed the sensitivity of our current PTT reagent to argatroban in May 2020. In plasma calibrators containing argatroban, we observed that 0.56 microgram/mL argatroban resulted in a PTT 1.8x baseline, 1.08 microgram/mL resulted in a PTT 2.2x baseline, 1.58 microgram/mL resulted in a PTT 2.5x baseline, and 2.07 microgram/mL resulted in a PTT 2.8x baseline. These results are generally similar to the information provided by the manufacturer and to the results of prior UCSF ex vivo spiking studies (performed in 2006, 2009, 2013, 2019).
On the basis of the information available, argatroban levels of 0.5-2.0 micrograms/mL can be considered therapeutic. These levels corresponded to 1.6x-2.7x baseline PTT in plasma without a lupus anticoagulant, which is within the manufacturer's recommended therapeutic PTT of 1.5x-3.0x patient baseline.
For adult patients without lupus anticoagulants an argatroban order form is available and should be utilized. The therapeutic PTT as of August 2017 was 52-67.9 seconds. For patients in whom the PTT cannot be used for monitoring, a derivative algorithm, based on a therapeutic target of 0.5-2.0 micrograms/mL, should be used for monitoring and dose adjustment, as clinically indicated. It is suggested that the Hematology Consultation service (415-443-4276) be contacted for recommendations regarding an appropriate algorithm for monitoring and dose adjustment in these patients.
The presence of heparin will interfere with the argatroban assay and can produce an erroneously elevated argatroban test result.
The information contained herein is applicable to patients receiving argatroban in the setting of heparin induced thrombocytopenia. If argatroban is being utilized in other settings, including percutaneous coronary interventions, it is suggested that the Hematology Consultation service (pager: 443-4276) and a physician in the coagulation laboratory (353-1747) be contacted.
Argatroban is usually monitored by the activated PTT. Rarely, however, plasma argatroban levels should be measured to give a more accurate estimate of clinical anticoagulation.
Lupus anticoagulants can prolong the PTT at baseline, or impact the PTT after a patient has begun heparin therapy. If a patient being treated with argatroban is known or suspected to have a lupus anticoagulant, an argatroban level and an aPTT should be sent simultaneously. If review of results of simultaneous argatroban and PTT measurements indicates that the patient's lupus anticoagulant is causing an artifactual PTT prolongation, subsequent monitoring with argatroban levels is indicated.
The manufacturer of argatroban, GlaxoSmithKline, provides complete prescribing information on its website: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020883s014lbl.pdf, including information on the association of plasma argatroban levels and the activated PTT. A portion of the relevant information from this March 2009 document is summarized in the following information:
"Laboratory Tests: Anticoagulation effects associated with Argatroban infusion at doses up to 40 mcg/kg/min correlate with increases of the activated partial thromboplastin time (aPTT)."
"Dosage Adjustment: After the initial dose of Argatroban, the dose can be adjusted as clinically indicated (not to exceed 10 mcg/kg/min), until the steady-state aPTT is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds)"
Patients for whom a lupus anticoagulant influences the PTT must be monitored with argatroban levels. Therapeutic levels are not recommended by the manufacturer, but the manufacturer does provide a graph that shows a relationship among representative PTT levels, ACT levels, infusion rates, and plasma Argatroban levels:
In Figure 1.Relationship at Steady State Between Argatroban Dose, Plasma Argatroban Concentration and Anticoagulant Effect: A 0.4 microgram/mL argatroban level corresponded to approximately 1.6x the baseline PTT whereas a 2.0 microgram/mL argatroban level corresponded to approximately 2.6x the baseline PTT.
At UCSF we have assessed the sensitivity of our current PTT reagent to argatroban in May 2020. In plasma calibrators containing argatroban, we observed that 0.56 microgram/mL argatroban resulted in a PTT 1.8x baseline, 1.08 microgram/mL resulted in a PTT 2.2x baseline, 1.58 microgram/mL resulted in a PTT 2.5x baseline, and 2.07 microgram/mL resulted in a PTT 2.8x baseline. These results are generally similar to the information provided by the manufacturer and to the results of prior UCSF ex vivo spiking studies (performed in 2006, 2009, 2013, 2019).
On the basis of the information available, argatroban levels of 0.5-2.0 micrograms/mL can be considered therapeutic. These levels corresponded to 1.6x-2.7x baseline PTT in plasma without a lupus anticoagulant, which is within the manufacturer's recommended therapeutic PTT of 1.5x-3.0x patient baseline.
For adult patients without lupus anticoagulants an argatroban order form is available and should be utilized. The therapeutic PTT as of August 2017 was 52-67.9 seconds. For patients in whom the PTT cannot be used for monitoring, a derivative algorithm, based on a therapeutic target of 0.5-2.0 micrograms/mL, should be used for monitoring and dose adjustment, as clinically indicated. It is suggested that the Hematology Consultation service (415-443-4276) be contacted for recommendations regarding an appropriate algorithm for monitoring and dose adjustment in these patients.
The presence of heparin will interfere with the argatroban assay and can produce an erroneously elevated argatroban test result.
| Ordering |
The information contained herein is applicable to patients receiving argatroban in the setting of heparin induced thrombocytopenia. If argatroban is being utilized in other settings, including percutaneous coronary interventions, it is suggested that the Hematology Consultation service (pager: 443-4276) and a physician in the coagulation laboratory (353-1747) be contacted.
Argatroban is usually monitored by the activated PTT. Rarely, however, plasma argatroban levels should be measured to give a more accurate estimate of clinical anticoagulation.
Lupus anticoagulants can prolong the PTT at baseline, or impact the PTT after a patient has begun heparin therapy. If a patient being treated with argatroban is known or suspected to have a lupus anticoagulant, an argatroban level and an aPTT should be sent simultaneously. If review of results of simultaneous argatroban and PTT measurements indicates that the patient's lupus anticoagulant is causing an artifactual PTT prolongation, subsequent monitoring with argatroban levels is indicated.
The manufacturer of argatroban, GlaxoSmithKline, provides complete prescribing information on its website: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020883s014lbl.pdf, including information on the association of plasma argatroban levels and the activated PTT. A portion of the relevant information from this March 2009 document is summarized in the following information:
"Laboratory Tests: Anticoagulation effects associated with Argatroban infusion at doses up to 40 mcg/kg/min correlate with increases of the activated partial thromboplastin time (aPTT)."
"Dosage Adjustment: After the initial dose of Argatroban, the dose can be adjusted as clinically indicated (not to exceed 10 mcg/kg/min), until the steady-state aPTT is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds)"
Patients for whom a lupus anticoagulant influences the PTT must be monitored with argatroban levels. Therapeutic levels are not recommended by the manufacturer, but the manufacturer does provide a graph that shows a relationship among representative PTT levels, ACT levels, infusion rates, and plasma Argatroban levels:
In Figure 1.Relationship at Steady State Between Argatroban Dose, Plasma Argatroban Concentration and Anticoagulant Effect: A 0.4 microgram/mL argatroban level corresponded to approximately 1.6x the baseline PTT whereas a 2.0 microgram/mL argatroban level corresponded to approximately 2.6x the baseline PTT.
At UCSF we have assessed the sensitivity of our current PTT reagent to argatroban in May 2020. In plasma calibrators containing argatroban, we observed that 0.56 microgram/mL argatroban resulted in a PTT 1.8x baseline, 1.08 microgram/mL resulted in a PTT 2.2x baseline, 1.58 microgram/mL resulted in a PTT 2.5x baseline, and 2.07 microgram/mL resulted in a PTT 2.8x baseline. These results are generally similar to the information provided by the manufacturer and to the results of prior UCSF ex vivo spiking studies (performed in 2006, 2009, 2013, 2019).
On the basis of the information available, argatroban levels of 0.5-2.0 micrograms/mL can be considered therapeutic. These levels corresponded to 1.6x-2.7x baseline PTT in plasma without a lupus anticoagulant, which is within the manufacturer's recommended therapeutic PTT of 1.5x-3.0x patient baseline.
For adult patients without lupus anticoagulants an argatroban order form is available and should be utilized. The therapeutic PTT as of August 2017 was 52-67.9 seconds. For patients in whom the PTT cannot be used for monitoring, a derivative algorithm, based on a therapeutic target of 0.5-2.0 micrograms/mL, should be used for monitoring and dose adjustment, as clinically indicated. It is suggested that the Hematology Consultation service (415-443-4276) be contacted for recommendations regarding an appropriate algorithm for monitoring and dose adjustment in these patients.
The presence of heparin will interfere with the argatroban assay and can produce an erroneously elevated argatroban test result.
| Collection |
| Processing |
| Result Interpretation |
The information contained herein is applicable to patients receiving argatroban in the setting of heparin induced thrombocytopenia. If argatroban is being utilized in other settings, including percutaneous coronary interventions, it is suggested that the Hematology Consultation service (pager: 443-4276) and a physician in the coagulation laboratory (353-1747) be contacted.
Argatroban is usually monitored by the activated PTT. Rarely, however, plasma argatroban levels should be measured to give a more accurate estimate of clinical anticoagulation.
Lupus anticoagulants can prolong the PTT at baseline, or impact the PTT after a patient has begun heparin therapy. If a patient being treated with argatroban is known or suspected to have a lupus anticoagulant, an argatroban level and an aPTT should be sent simultaneously. If review of results of simultaneous argatroban and PTT measurements indicates that the patient's lupus anticoagulant is causing an artifactual PTT prolongation, subsequent monitoring with argatroban levels is indicated.
The manufacturer of argatroban, GlaxoSmithKline, provides complete prescribing information on its website: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020883s014lbl.pdf, including information on the association of plasma argatroban levels and the activated PTT. A portion of the relevant information from this March 2009 document is summarized in the following information:
"Laboratory Tests: Anticoagulation effects associated with Argatroban infusion at doses up to 40 mcg/kg/min correlate with increases of the activated partial thromboplastin time (aPTT)."
"Dosage Adjustment: After the initial dose of Argatroban, the dose can be adjusted as clinically indicated (not to exceed 10 mcg/kg/min), until the steady-state aPTT is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds)"
Patients for whom a lupus anticoagulant influences the PTT must be monitored with argatroban levels. Therapeutic levels are not recommended by the manufacturer, but the manufacturer does provide a graph that shows a relationship among representative PTT levels, ACT levels, infusion rates, and plasma Argatroban levels:
In Figure 1.Relationship at Steady State Between Argatroban Dose, Plasma Argatroban Concentration and Anticoagulant Effect: A 0.4 microgram/mL argatroban level corresponded to approximately 1.6x the baseline PTT whereas a 2.0 microgram/mL argatroban level corresponded to approximately 2.6x the baseline PTT.
At UCSF we have assessed the sensitivity of our current PTT reagent to argatroban in May 2020. In plasma calibrators containing argatroban, we observed that 0.56 microgram/mL argatroban resulted in a PTT 1.8x baseline, 1.08 microgram/mL resulted in a PTT 2.2x baseline, 1.58 microgram/mL resulted in a PTT 2.5x baseline, and 2.07 microgram/mL resulted in a PTT 2.8x baseline. These results are generally similar to the information provided by the manufacturer and to the results of prior UCSF ex vivo spiking studies (performed in 2006, 2009, 2013, 2019).
On the basis of the information available, argatroban levels of 0.5-2.0 micrograms/mL can be considered therapeutic. These levels corresponded to 1.6x-2.7x baseline PTT in plasma without a lupus anticoagulant, which is within the manufacturer's recommended therapeutic PTT of 1.5x-3.0x patient baseline.
For adult patients without lupus anticoagulants an argatroban order form is available and should be utilized. The therapeutic PTT as of August 2017 was 52-67.9 seconds. For patients in whom the PTT cannot be used for monitoring, a derivative algorithm, based on a therapeutic target of 0.5-2.0 micrograms/mL, should be used for monitoring and dose adjustment, as clinically indicated. It is suggested that the Hematology Consultation service (415-443-4276) be contacted for recommendations regarding an appropriate algorithm for monitoring and dose adjustment in these patients.
The presence of heparin will interfere with the argatroban assay and can produce an erroneously elevated argatroban test result.
| Administrative |
| Complete View |
The information contained herein is applicable to patients receiving argatroban in the setting of heparin induced thrombocytopenia. If argatroban is being utilized in other settings, including percutaneous coronary interventions, it is suggested that the Hematology Consultation service (pager: 443-4276) and a physician in the coagulation laboratory (353-1747) be contacted.
Argatroban is usually monitored by the activated PTT. Rarely, however, plasma argatroban levels should be measured to give a more accurate estimate of clinical anticoagulation.
Lupus anticoagulants can prolong the PTT at baseline, or impact the PTT after a patient has begun heparin therapy. If a patient being treated with argatroban is known or suspected to have a lupus anticoagulant, an argatroban level and an aPTT should be sent simultaneously. If review of results of simultaneous argatroban and PTT measurements indicates that the patient's lupus anticoagulant is causing an artifactual PTT prolongation, subsequent monitoring with argatroban levels is indicated.
The manufacturer of argatroban, GlaxoSmithKline, provides complete prescribing information on its website: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020883s014lbl.pdf, including information on the association of plasma argatroban levels and the activated PTT. A portion of the relevant information from this March 2009 document is summarized in the following information:
"Laboratory Tests: Anticoagulation effects associated with Argatroban infusion at doses up to 40 mcg/kg/min correlate with increases of the activated partial thromboplastin time (aPTT)."
"Dosage Adjustment: After the initial dose of Argatroban, the dose can be adjusted as clinically indicated (not to exceed 10 mcg/kg/min), until the steady-state aPTT is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds)"
Patients for whom a lupus anticoagulant influences the PTT must be monitored with argatroban levels. Therapeutic levels are not recommended by the manufacturer, but the manufacturer does provide a graph that shows a relationship among representative PTT levels, ACT levels, infusion rates, and plasma Argatroban levels:
In Figure 1.Relationship at Steady State Between Argatroban Dose, Plasma Argatroban Concentration and Anticoagulant Effect: A 0.4 microgram/mL argatroban level corresponded to approximately 1.6x the baseline PTT whereas a 2.0 microgram/mL argatroban level corresponded to approximately 2.6x the baseline PTT.
At UCSF we have assessed the sensitivity of our current PTT reagent to argatroban in May 2020. In plasma calibrators containing argatroban, we observed that 0.56 microgram/mL argatroban resulted in a PTT 1.8x baseline, 1.08 microgram/mL resulted in a PTT 2.2x baseline, 1.58 microgram/mL resulted in a PTT 2.5x baseline, and 2.07 microgram/mL resulted in a PTT 2.8x baseline. These results are generally similar to the information provided by the manufacturer and to the results of prior UCSF ex vivo spiking studies (performed in 2006, 2009, 2013, 2019).
On the basis of the information available, argatroban levels of 0.5-2.0 micrograms/mL can be considered therapeutic. These levels corresponded to 1.6x-2.7x baseline PTT in plasma without a lupus anticoagulant, which is within the manufacturer's recommended therapeutic PTT of 1.5x-3.0x patient baseline.
For adult patients without lupus anticoagulants an argatroban order form is available and should be utilized. The therapeutic PTT as of August 2017 was 52-67.9 seconds. For patients in whom the PTT cannot be used for monitoring, a derivative algorithm, based on a therapeutic target of 0.5-2.0 micrograms/mL, should be used for monitoring and dose adjustment, as clinically indicated. It is suggested that the Hematology Consultation service (415-443-4276) be contacted for recommendations regarding an appropriate algorithm for monitoring and dose adjustment in these patients.
The presence of heparin will interfere with the argatroban assay and can produce an erroneously elevated argatroban test result.
