argatroban / Generic mfg. - LARVOL DELTA

Ecarin-based coagulation monitoring of argatroban in patients with heparin-induced thrombocytopenia: a prospective observational study. (PubMed, Br J Anaesth) - "This study presents ECA-CT as a reliable point-of-care test for monitoring argatroban concentration in patients with HIT. aPTT demonstrated a pronounced inability to track argatroban concentrations, especially when aPTT was >55 s. These findings highlight the need to reconsider optimal anticoagulation targets when using argatroban."

Journal • Observational data • Cardiovascular • Hematological Disorders • Thrombocytopenia

Targeting MORF4L1-mediated DNA repair potentiates RT-induced antitumor immunity via cGAS-STING activation in hepatocellular carcinoma. (PubMed, Cell Mol Immunol) - "This combination significantly improved the therapeutic efficacy of RT when used alongside immune checkpoint inhibitors. The study findings underscore the pivotal role of MORF4L1 in hepatocellular carcinoma progression and RT resistance, suggesting that combining argatroban with RT may overcome RT resistance and improve therapeutic outcomes."

Journal • Hepatocellular Cancer • Oncology • Solid Tumor • Targeted Protein Degradation • BRCA2 • CGAS • STING

Thrombomodulin-Induced Prevention of Peripheral Neuropathy in Oxaliplatin-Treated Mice Involves Complement C5a Inactivation and PAR1 Activation in Addition To HMGB1 Degradation. (PubMed, J Neuroimmune Pharmacol) - "Oxaliplatin significantly increased plasma C5a levels in the mice treated with argatroban, a thrombin inhibitor, capable of reducing the degradation of HMGB1 by the endogenous thrombin-thrombomodulin axis. Our data thus suggest that the anti-OIPN effect of TMα involves APC-induced PAR1 activation and TAFIa-induced degradation of C5a that induces HMGB1-dependent pain, in addition to HMGB1 degradation."

Journal • Preclinical • Pain • Peripheral Neuropathic Pain • HMGB1

Medical and perioperative management of acute and subacute heparin-induced thrombocytopenia in adults requiring urgent cardiopulmonary bypass surgery. (ASH 2025) - "After diagnosis of HIT, most were started on the alternative anticoagulants argatroban or bivalirudin(bival) in 0-1 days...These cases(each n=1) were not grouped: IO heparin+tirofiban with pre-op PLEX+IVIG, IO heparin alone, IO heparinwith pre-op plus IO PLEX, and 1 who died before planned surgery...IO bival appears to increase risk of IO and post-op bleeding but conclusions are limited bysample size. Larger, comparative studies are needed to determine and characterize the optimalmanagement approach for this unique clinical scenario."

Clinical • Surgery • Acute Kidney Injury • Cardiovascular • Hematological Disorders • Infectious Disease • Nephrology • Renal Disease • Thrombocytopenia • Thrombosis

Cost-effectiveness of heparin-induced thrombocytopenia (HIT) diagnostic strategies: Rapid PF4/heparin versus ELISA-based antibody testing strategies in the care of hospitalized people with suspected HIT (ASH 2025) - "All patients in an ELISA-based strategy were switched to non-heparinanticoagulation whereas patients in a rapid-based strategy were switched only if the assay was positive.Both bivalirudin (base-case) and argatroban (scenario analysis) were examined. This is achieved by reducing thecosts associated with unnecessary non-heparin anticoagulation and major bleeds in patients who testnegative for HIT. In addition, our model allows individual stakeholders to assess cost-effectiveness basedon their own quoted coagulation analyzer price and expected annual volume of HIT diagnostic tests."

Clinical • Cost effectiveness • HEOR • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

HIT or miss?: Long-term outcomes of direct thrombin inhibitors vs fondaparinux use in heparin-induced thrombocytopenia (ASH 2025) - "Cohort A had 1489patients diagnosed with HIT and treated with fondaparinux while Cohort B had 1489 patients diagnosedwith HIT and treated with direct thrombin inhibitors (argatroban, bivalirudin, lepirudin or desirudin). Our study provides evidence that fondaparinux significantly reduces the risk of mortality and adverseevents including myocardial infarction, skin necrosis, arterial embolism/thrombosis and moderate tosevere thrombocytopenia at one year compared to DTIs for the management of HIT. In addition to theseclinical benefits, fondaparinux offers cost advantages and ease of use, with its subcutaneousadministration, predictable pharmacokinetics, and minimal need for laboratory monitoring making itparticularly useful in outpatient and resource-limited settings. However, fondaparinux carries anincreased risk of major bleeding, particularly intracranial hemorrhage, due to the lack of a reversal agent.It is also contraindicated in patients with renal impairment and..."

Fibrosis • Heart Failure • Immunology

Cost effectiveness of in-house HIT screening testing in community based hospital (ASH 2025) - "Empiric anticoagulation was initiated in 147 (28.8%) patients, withargatroban in 85 (57.8%), fondaparinux in 50 (34.0%), and 12 (8.2%) receiving other anticoagulants(apixaban, rivaroxaban, or bivalirudin)...Only 48 (18.6%) patients received empiricanticoagulation, with argatroban used in 25 (52.1%), fondaparinux in 17 (35.4%), and otheranticoagulants (apixaban and bivalirudin) in 6 (12.5%)...Theimplementation of in-house HIT screening tests resulted in an annual cost saving of $17,181 inanticoagulation alone. ConclusionImplementation of the HIT testing algorithm using an in-house screening test with a reflex outsourcedconfirmatory test resulted in decreased turnaround time, reduction of empiric anticoagulation utilization,and potential cost savings for hospitalized patients with suspected HIT."

Clinical • Cost effectiveness • HEOR • Hematological Disorders • Thrombocytopenia

Injectable pentosan polysulfate: A novel cause of heparin-induced thrombocytopenia and stroke (ASH 2025) - "Aspirin and Atorvastatin were initiated, and Clopidogrel was deferred due to continuedthrombocytopenia.Due to the unusual presentation of ischemic stroke and isolated thrombocytopenia in a young femalewithout traditional risk factors, a comprehensive diagnostic evaluation was pursued. PPS was therefore identified as thelikely HIT trigger and the patient was treated with Argatroban and transitioned to Apixaban, with plateletcount recovery to 204x10³/μL.This case illustrates the importance of maintaining a broad differential when encountering unexplainedthrombocytopenia and thrombosis, as HIT may arise from unconventional exposures. Obtaining adetailed medication history, which includes unregulated and non-prescribed medications, is essential toidentifying a diagnosis."

Cardiovascular • Fatigue • Hematological Disorders • Immunology • Interstitial Cystitis • Ischemic stroke • Osteoarthritis • Rheumatology • Thrombocytopenia

Management of heparin-induced thrombocytopenia in impella-supported cardiac surgery: A comprehensive four-patient case series with novel anticoagulation strategies (ASH 2025) - "Each patient received a distinct:ultra-low-dose argatroban purge, bivalirudin purge with systemic therapy, therapeutic plasma exchange(TPE) plus intravenous immunoglobulin (IVIg) enabling UFH re-exposure, and heparin-free bicarbonatepurge. Median age was 58 years (range 47-71). Individualized, guideline-concordant anticoagulation strategies—including novel purgesolutions and immunomodulatory approaches—enable safe Impella support in HIT patients undergoingcomplex cardiac surgery."

Clinical • Surgery • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

The clinical trial of argatroban for the prevention of early neurological deterioration in acute ischemic stroke: multicenter, prospective, open-label, endpoint-blinded, randomized controlled phase 2 clinical trial (ChiCTR) - P4 | N=269 | Not yet recruiting | Sponsor: Shantou Central Hospital; Shantou Central Hospital

New P4 trial • Cardiovascular • Ischemic stroke

Use Of Argatroban Plus Antiplatelet Therapy In Patients With Non-Cardioembolic Stroke: A Systematic Review And Meta-Analysis. (AHA 2025) - "No statistically significant difference in change in NIHSS (RR=0.11, 95%CI: -0.50-0.72, P=0.73) and ICH (RR=0.94, 95%CI: 0.56-1.59, P=0.83).In non-cardioembolic stroke, the use of argatroban in combination with antiplatelet therapy showed better results than antiplatelet therapy alone in terms of functional outcome and prevention of neurological deficit, with no significant increase in intracranial haemorrhage and no change in NIHSS. Further randomised clinical trials are needed to confirm these results."

Retrospective data • Review • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke

Fatal Pulmonary Embolism Following Intravascular Cooling for TTM in a Young Cardiac Arrest Survivor (AHA 2025) - "Heparin was started on Day 1 and transitioned to enoxaparin.Differential Diagnosis: Initial considerations included myocardial infarction, pulmonary embolism, primary arrhythmia, and toxic/metabolic causes...HIT IgG returned positive; anticoagulation was switched to argatroban...Early DVT surveillance, pharmacologic thromboprophylaxis, and daily reassessment of catheter need are critical. When thrombotic risk is elevated, such as in cardiogenic shock or low-flow states, choosing the least harmful modality is essential."

Cardiovascular • Gastroesophageal Reflux Disease • Genetic Disorders • Myocardial Infarction • Pulmonary Embolism • Respiratory Diseases

Aortoenteric Fistula Beyond the Duodenum: Graft Erosion Into the Proximal Jejunum (ACG 2025) - "Anticoagulation was switched from heparin to argatroban due to suspected failure. This case highlights a rare variant of aortoenteric fistula, involving erosion into the jejunum rather than the more commonly affected duodenum. The patient's surgical history was significant for multiple aortobifemoral graft complications over a two-year span, including right femoral anastomotic dehiscence, recurrent thrombotic occlusion of the left graft limb, and multiple vascular revisions. These repeated interventions likely contributed to the eventual graft-enteric erosion.Figure: 1-CT imaging revealed thickened jejunal mucosa with concern for a possible fistulous tract.2-Upper endoscopy showed a jejunal ulcer with exposed vascular graft material at its base.3, 4-Surgical exploration confirmed the presence of a large fistulous connection between the graft and the jejunum."

Addiction (Opioid and Alcohol) • Anemia • Cardiovascular • Dyslipidemia • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hypertension • Thrombosis

A Storm of Clots: Unmasking Catastrophic Antiphospholipid Syndrome in a Case of Rapid Multi-Vessel Thrombosis (ACG 2025) - "The presence of antiphospholipid antibodies, such as anticardiolipin antibodies, plays a crucial role in pathogenesis.Case Description/ A 49-year-old male with a history of unprovoked left leg DVT presented with abdominal pain 7 days after stopping Eliquis...Although initial HIT antibodies were positive, thrombocytopenia was present before heparin, and serotonin release assays were negative which rose concern for CAPS so quadruple therapy with steroids, plasma exchange, aspirin, and Argatroban was initiated...The patient was transitioned to weight-based enoxaparin with stable platelet counts. This case highlights the urgency and complexity of CAPS...Plasmapheresis played a key therapeutic role but initially caused false-negative antiphospholipid antibody results. However, testing 10 days after the final session helps confirm the CAPS diagnosis.Figure: Surgical specimen pathologic findings show evidence of microvascular thrombosis."

Clinical • Cardiovascular • Complement-mediated Rare Disorders • Genetic Disorders • Hematological Disorders • Immunology • Infectious Disease • Inflammatory Arthritis • Ischemic stroke • Thrombocytopenia • Thrombosis

A CASE OF CAROTID FREE-FLOATING THROMBUS TREATED WITH DIRECT THROMBIN INHIBITOR (WSC 2025) - "After 5 days of argatroban treatment, the anticoagulant was changed to edoxaban 30mg. Argatroban, unlike heparin, does not require blood test monitoring and has safety profile for bleeding side effects, making it a viable option for the acute treatment of FFT. This report adds to the limited literature on carotid FFT management and underscores the role of direct thrombin inhibitors, such as argatroban, as a safe and effective treatment option for acute cases."

Clinical • Cardiovascular • Ischemic stroke • Thrombosis

ARGATROBAN AND ANTIPLATELET THERAPY COMPARED TO ANTIPLATELET THERAPY IN PATIENTS WITH NON-CARDIOEMBOLIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 2,861 PATIENTS. (WSC 2025) - "No statistically significant difference in change in NIHSS (RR=0.11, 95%CI: -0.50-0.72, P=0.73) and ICH (RR=0.94, 95%CI: 0.56-1.59, P=0.83).ConclusionsIn non-cardioembolic stroke, the use of argatroban in combination with antiplatelet therapy showed better results than antiplatelet therapy alone in terms of functional outcome and prevention of neurological deficit, with no significant increase in intracranial haemorrhage and no change in NIHSS. Further randomised clinical trials are needed to confirm these results."

Retrospective data • Review • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke

MASSIVE HEMOPTYSIS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME IN THE SETTING OF UNDIAGNOSED PULMONARY HYPERTENSION (CHEST 2025) - "Given his autoimmune history, he was empirically administered IV methylprednisolone for possible autoimmune flare. Warfarin was held and an argatroban drip was initiated given a documented allergy to heparin... Massive hemoptysis requires simultaneous workup and treatment of several possible etiologies given the broad differential diagnosis and risk for acute clinical deterioration."

Clinical • Cardiovascular • Chronic Kidney Disease • Cough • Genetic Disorders • Glomerulonephritis • Hematological Disorders • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Pneumonia • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Renal Disease • Respiratory Diseases • Systemic Lupus Erythematosus • Tuberculosis

PLATELET PLUNGE: A CASE OF THROMBOCYTOPENIA FOLLOWING HEPARIN THERAPY AND INFLUENZA INFECTION (CHEST 2025) - "To manage the thrombocytopenia, argatroban therapy was initiated...No additional bleeding events occurred, and the patient was subsequently restarted on apixaban for thromboprophylaxis... This underscores the importance of considering all potential causes of thrombocytopenia, particularly when multiple factors may contribute to the patient's clinical presentation."

Clinical • Cardiovascular • Coronary Artery Disease • Diabetes • Fatigue • Hematological Disorders • Hypertension • Infectious Disease • Influenza • Metabolic Disorders • Respiratory Diseases • Thrombocytopenia • Thrombosis

BALANCING BLEEDING AND CLOTTING: A COMPLEX CASE OF SUBSEGMENTAL PULMONARY EMBOLISM AND SYMPTOMATIC ANEMIA IN A YOUNG FEMALE WITH ANTIPHOSPHOLIPID SYNDROME (CHEST 2025) - "CASE PRESENTATION: A 26-year-old female with a history of anti-phospholipid syndrome (APS) and prior deep vein thrombosis (DVT) requiring mechanical thrombectomy, who had been on rivaroxaban for anticoagulation, presented with shortness of breath, chest pain, and headache...Heparin was discontinued, and the patient was briefly transitioned to an argatroban infusion while HIT was ruled out...After carefully considering the risks and benefits, including potential complications associated with pregnancy, the patient ultimately chose warfarin. This case emphasizes the importance of shared decision-making with patients regarding anticoagulation therapy to optimize outcomes in individuals with APS, particularly those at high thrombotic risk complicated by concomitant blood-loss anemia."

Clinical • Anemia • Cardiovascular • Genetic Disorders • Hematological Disorders • Immunology • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

A COMPLEX CASE OF NSTEMI, HIT, AND PULMONARY EMBOLISM: NAVIGATING ANTICOAGULATION THERAPY AND BLEEDING RISKS (CHEST 2025) - "He received heparin, aspirin, and Plavix before undergoing emergent cardiac catheterization with stent placement in the right coronary artery (RCA)...As his platelet count and hemoglobin stabilized, he was transitioned to Eliquis when deemed safe and later restarted on Plavix... Managing a patient with NSTEMI, HIT, PE, and active gastrointestinal bleeding requires early recognition, timely anticoagulation adjustments, and close multidisciplinary collaboration. HIT diagnosis necessitates alternative anticoagulants like argatroban, followed by the transition to oral anticoagulation when safe. This case highlights the challenges of balancing anticoagulation and antiplatelet therapy while preventing both recurrent thrombotic events and life-threatening bleeding, underscoring the importance of individualized, multidisciplinary management strategies."

Clinical • Cardiovascular • Gastroenterology • Hematological Disorders • Myocardial Infarction • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

HEPARIN-INDUCED THROMBOCYTOPENIA COMPLICATING MANAGEMENT OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION (CHEST 2025) - "She had been diagnosed with a pulmonary embolism (PE) several months prior and was started on rivaroxaban...She was switched from heparin to argatroban infusion and was transferred to a higher level of care for CTEPH management.After joint evaluation by the pulmonary hypertension and cardiothoracic surgery teams, pulmonary endarterectomy was offered for definitive management of her CTEPH...She was discharged on warfarin and sildenafil with plans to have endarterectomy scheduled three months after her HIT diagnosis... HIT is an intensely prothrombotic disorder. There are very limited examples for its management in the setting of urgent or emergent need for cardiopulmonary bypass. In non-emergent cases, delaying surgery is the ideal option to allow the HIT antibodies to become undetectable."

Cardiovascular • Congestive Heart Failure • Genetic Disorders • Heart Failure • Hematological Disorders • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

Renal Thrombotic Microangiopathy as the Primary Manifestation of Heparin-Induced Thrombocytopenia: A Diagnostic and Therapeutic Challenge (KIDNEY WEEK 2025) - "Anticoagulation was switched to bivalirudin...Argatroban failure suggests HIT-TMA may need more aggressive anticoagulation. This case redefines HIT’s renal spectrum & biopsy’s diagnostic role. Glomerulus with features of acute TMA including endothelial swelling, RBC fragmentation, karyorrhexis"

Atypical Hemolytic Uremic Syndrome • Cardiovascular • Complement-mediated Rare Disorders • Hematological Disorders • Nephrology • Thrombocytopenia • Thrombosis • Vasculitis • HP

Nafamostat Mesilate as an Anticoagulation Strategy for Heparin-Induced Thrombocytopenia (KIDNEY WEEK 2025) - "Heparin was discontinued, and anticoagulation transitioned to argatroban and later nafamostat mesilate due to argatroban shortage. Key questions remain regarding heparin rechallenge safety, causative agent identification in multi-heparin exposure, and rapid differentiation of HIT from anaphylactoid reactions. Further studies are needed to optimize HIT management in high-risk populations."

Cardiovascular • Chronic Kidney Disease • Hematological Disorders • Nephrology • Renal Disease • Thrombocytopenia

Argatroban-Associated Adverse Events: An Analysis Based on FDA Adverse Event Reporting System (FAERS). (PubMed, Cardiovasc Toxicol) - "The median time to event was 2.00 days, with the majority of AEs occurring within 30 days. Analysis of the FAERS database identified argatroban-associated AEs, including newly identified potential risks with the aim of enhancing clinicians' and pharmacists' awareness of drug-related risk signals and facilitate timely preventive and treatment interventions for patient safety."

Adverse events • Journal • Cardiovascular • Congestive Heart Failure • Heart Failure • Hematological Disorders • Thrombocytopenic Purpura

Design and Evaluation of Sticky End-Type Bivalent DNA Aptamers Containing M08s-1 as Anticoagulant Agents. (PubMed, ChemMedChem) - "Among them, the heterobivalent aptamer Pse08-29 exhibits the most potent ex vivo anticoagulant activity, surpassing the approved drug argatroban...Finally, selected bivalent aptamers, consisting of two split DNA strands (<65 mer), exhibit the high anticoagulant activity as well as Pse08-29. This highlights not only efficient nucleobase reduction with preserved function but also a new design strategy for bivalent aptamers."

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