Argatroban is a first-line anticoagulant used to treat individuals with heparin-induced thrombocytopenia (HIT). There was a dearth of published data on the practical implications of its application in HIT. For a study, researchers intend to provide recommendations based on their expertise. It was the biggest cohort of 32 people presenting instances of HIT verified by a functional test and treated with argatroban. Starting argatroban doses (SAD) of 0.54, 0.98, and 1.27 μg/kg/min achieved steady-state plasmatic argatroban concentrations (PAC) of 0–0.39, 0.40–0.99, and 1.00–1.5 μg/ml, respectively, in individuals with normal liver function. Median argatroban dosage increments (ADI) resulted in comparable median steady-state PAC increases (Δ μg/kg/min ≈ Δ μg/ml). PAC measures were taken more than 240 minutes after SAD or ADI were considerably greater than earlier controls. Monitoring looked to be satisfactory with quantitative PAC measures and thrombin time (TT). 

PAC levels less than 0.4 μg/ml were shown to be associated with 38% of thrombotic events. The median international normalized ratio (INR) drops four hours after argatroban termination was 1.2. They recommended the following: monitoring argatroban with PAC or TT at least 240 minutes after SAD and/or AID; using SAD of 1.0 μg/kg/min and ADI of at least 0.2 μg/kg/min when liver function is normal; targeting therapeutic PAC of 0.5–1.0 μg/ml, and targeting INR of 3.5–4.5 when bridging argatroban with vitamin K antagonists. 

Reference:onlinelibrary.wiley.com/doi/10.1111/bjh.18120