ABSTRACT
Argatroban is the smallest molecule of the anticoagulant class of direct thrombin inhibitors. The
main attributes of this synthetic drug are its rapid onset of antithrombin action, the rapid
reversibility of its anticoagulant effect, the potent inhibition of clot-bound thrombin, the absence
of antibody formation, and no need for dosage adjustment in patients with renal impairment; it is
eliminated by hepatic metabolism. These properties make argatroban a predictable anticoagulant
with intravenous use in a routine clinical setting. Argatroban is approved in the United States for
both prophylaxis and treatment of thrombosis in patients with heparin-induced thrombocytope-
nia (HIT). In limited trials it has also provided reliable anticoagulation during percutaneous
coronary interventions on patients with HIT. Preliminary reports document the feasibility of
using argatroban for anticoagulation during peripheral vascular interventions, hemodialysis, and
as adjuct to thrombolysis in acute ST-elevation myocardial infarction. A consistent safety profile
of argatroban has been demonstrated in all studies to date. Current recommendations for
argatroban monitoring are to use the activated partial thromboplastin time (aPTT) for low doses
and the activated clotting time (ACT) for high doses. Argatroban continues to be studied as an
antithrombotic agent in various clinical settings.
