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Argatroban

Test code(s) 90413

Question 1. What is argatroban?

Argatroban is a direct thrombin inhibitor indicated for prophylaxis or treatment of thrombosis in adult patients with heparin-induced thrombocytopenia.  Argatroban therapy is typically monitored using an aPTT (1.5 to 3.0 x baseline) or activated clotting time (ACT) test.

Question 2. When should argatroban levels be obtained?

Argatroban testing should be considered when the aPTT is not reliable for therapeutic monitoring, as in the case of a lupus anticoagulant. Conversely, testing should not be performed when the patient is taking an anticoagulant that affects the aPTT (eg, unfractionated heparin); such anticoagulants may affect the argatroban result.

Argatroban testing can also be used to verify the results of the aPTT/ACT monitoring.

Question 3. Which method is used for argatroban testing?

A dilute thrombin clotting time method (functional assay) is used. The clotting time obtained is directly related to the concentration of argatroban in the patient specimen. Results are reported in mcg/mL.

The assay uses argatroban calibrators, the concentrations of which have been verified by liquid chromatography, tandem mass spectrometry (LC/MS/MS). To determine the argatroban level, the clotting time of the patient plasma is compared to the clotting time of the argatroban calibrators.

Question 4. What is the reportable range of this assay?

The analytical measurement range (AMR) of the assay is 0.16 to 1.95 mcg/mL. After sample dilution, concentrations up to 3.00 mcg/mL can be reported.

Question 5. When are steady-state levels of argatroban typically attained?

Steady state is typically attained within one to three hours, since the half-life ranges between 39 and 51 minutes.1 Blood specimens should be collected during the steady state.

Question 6. What prophylactic and/or therapeutic levels are considered adequate?

Based on steady state correlation studies, argatroban levels between 0.5 and 2.0 micrograms/mL are considered adequate, as they correspond to an aPTT between 1.5 to 3.0 x baseline in adults.1

Reference

  1. Argatroban [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2016.
This FAQ is provided for informational purposes only and is not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.
Document FAQS.63 Version: 1
Version 1 effective 01/11/2017 to present
Version 0 effective 05/30/2012 to 01/11/2017