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Test Catalog

Test ID: ARGAT    
Argatroban, Ecarin, Plasma

Useful For Suggests clinical disorders or settings where the test may be helpful

Measuring argatroban concentration in plasma

 

This assay is not useful for measurement of other direct thrombin inhibitors eg, dabigatran or bivalirudin.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Argatroban, a parenteral direct thrombin inhibitor (DTI) that directly inhibits factor IIa, is indicated for use in patients with heparin-induced thrombocytopenia (HIT). Argatroban is administered via continuous infusion, is eliminated by the liver, and can inhibit both soluble and clot-bound thrombin. Argatroban effect is typically monitored using activated partial thromboplastin time (APTT) measurements with a target of 1.5 to 3.0 times the patient’s baseline value. However, in instances where patients have a prolonged baseline APTT (eg, lupus anticoagulants and factor XII deficiency), APTT monitoring of argatroban is not reliable and measurement of argatroban's effect on factor IIa may be more reliable.

 

There are no clinical studies directly correlating argatroban concentration to clinical outcomes. The available data suggest that plasma concentrations of argatroban 1.2 to 2.3 mcg/mL correspond to an APTT ratio of 1.5 to 3.0.(1)

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

<0.10 mcg/mL

Interpretation Provides information to assist in interpretation of the test results

Therapeutic reference ranges have not been established. See Clinical Information for activated partial thromboplastin time correlative information.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Routine monitoring of argatroban drug levels is not indicated, the recommended monitoring per product guidelines is with the activated partial thromboplastin time.

 

Argatroban concentration may be affected by drug interactions, liver and renal disease.

 

Marked presence of lipemia or bilirubin in the sample could falsely decrease argatroban levels.

Supportive Data

The lower limit of detection of this assay is 0.10 mcg/mL.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Ahmad S, Iqbal O, Ahsan A, et al: Clinical laboratory monitoring of a synthetic antithrombin agent, argatroban, using high performance liquid chromatography and functional methods. Int Angiol. 1999;18:198-205

2. Argatroban Injection. Package insert: Sandoz, Inc; 2019

3. Van Cott EM, Roberts AJ, Dager WE: Laboratory monitoring of parenteral direct thrombin inhibitors. Semin Thromb Hemost. 2017;43: 270-276

4. Gosselin RC, King JH, Janatpour KA, et al: Comparing direct thrombin inhibitors using aPTT, Ecarin clotting times, and thrombin inhibitor management testing. Ann Pharmacother. 2004;38:1383-1388

5. Gosselin RC, Adcock DM, Bates SM, et al: International Council for Standardization in Haematology (ICSH) recommendations for laboratory measurement of direct oral anticoagulants. Thromb Haemost. 2018 Mar;118(3):437-450

6. Lind SE, Boyle ME, Fisher S, Ishimoto J, Trujillo TC, Kiser TH: Comparison of the aPTT with alternative tests for monitoring direct trombin inhibitors in patient samples. Am J Clin Pathol. May 2014;141:665-674

7. Curvers J, van de Kerkhof D, Stroobants AK, van den Dool EJ, Scharnhorst V: Measuring direct thrombin inhibitors with routine and dedicated coagulation assays.  Am J Clin Pathol. 2012;138: 551-558

8. Seidel H, Kolde HJ: Monitoring of argatroban and lepirudin: what is the input of laboratory values in "real life"?  Clin Appl Thromb Hemost .2018 Mar;24(2):287-294

9. Fenyvesi T, Jorg I, Harenberg J: Monitoring of anticoagulant effects of direct thrombin inhibitors. Semin Thromb Hemost. 2002;28(4):361-368

Special Instructions Library of PDFs including pertinent information and forms related to the test