argatroban / Generic mfg. - LARVOL DELTA

Timely Initiation of Argatroban Improves Prognosis in Patients With Acute Ischemic Stroke Attributed to Large Artery Atherosclerosis: A Cohort Study. (PubMed, Brain Behav) - "This is the first study to demonstrate that timely argatroban initiation may improve clinical outcomes in thrombolysis-naive patients with LAA AIS. However, the results should be interpreted with caution due to the study's retrospective design and limited sample size."

Journal • Retrospective data • Atherosclerosis • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

Letter Regarding Article, "Exploring the Efficacy and Safety of Argatroban as an Adjunct to Antiplatelet Therapy in Ischemic Stroke Patients: a Systematic Review and Meta-Analysis". (PubMed, Transl Stroke Res) - No abstract available

Journal • Retrospective data • Cardiovascular • Ischemic stroke

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

Site-Specific Antithrombotic Therapy: 24-Month Outcomes of the Randomized DESyne BDS Plus Trial Using a Novel Triple-Drug Eluting Coronary Implant With Two Anticoagulants and Sirolimus. (PubMed, Catheter Cardiovasc Interv) - "This is the first clinical evidence of the feasibility of site-specific antithrombotic therapeutic with two anticoagulants and an antiproliferative mTOR inhibitor."

Journal • Cardiovascular • Hematological Disorders • Thrombosis

Rapid-Onset Heparin-Induced Thrombocytopenia Leading to Cardiogenic Shock Due to Left Anterior Descending Artery Embolism During Transcatheter Aortic Valve Replacement. (PubMed, Cureus) - "Although we hesitated to initiate argatroban therapy under these circumstances, heparin was discontinued...Although intraoperative findings suggestive of HIT were observed, distinguishing these from other TAVR-related complications proved clinically challenging, leading to a delayed diagnosis. This case report underscores the importance of recognizing the risk of HIT in patients with a history of heparin exposure and highlights critical areas for improvement in perioperative management strategies."

Journal • Anesthesia • Cardiovascular • CNS Disorders • Critical care • Hematological Disorders • Thrombocytopenia • Thrombosis

Management of Perioperative Heparin-Induced Thrombocytopenia (HIT) with Pre-Operative Plasmapheresis and Intra-Operative IV Epoprostenol Infusion in a Patient with Thrombosed Mechanical Tricuspid Valve (TV) (ASA 2025) - "Intravenous heparin (UFH) was initiated and re-do TV replacement scheduled...Considering the risks of using bivalirudin or argatroban during cardiopulmonary bypass (CPB), the decision was made to proceed with pre-operative plasmapheresis and use of UFH during CPB. This was facilitated by IV epoprostenol use prior to and during systemic anticoagulation. No complications related to HIT were reported post-operatively."

Clinical • Hematological Disorders • Thrombocytopenia

Anticoagulation during AngioVac Suction Thrombectomy in a Patient with End-Stage Renal Disease and Heparin-Induced Thrombocytopenia (ASA 2025) - "Decision making for intraoperative anticoagulation was complicated by ESRD, which relatively contraindicated bivalirudin. Argatroban was used with activated clotting time monitoring. There is limited literature guidance on argatroban use for partial CPB."

Clinical • Chronic Kidney Disease • Dermatology • Hematological Disorders • Nephrology • Pulmonary Embolism • Renal Disease • Thrombocytopenia

Aortic Valve Replacement for Infective Endocarditis Complicated by Heparin-Induced Thrombocytopenia and Intraoperative Pulmonary Shunting (ASA 2025) - "62-year-old man with aortic valve endocarditis presented with embolic limb ischemia requiring thromboembolectomy and fasciotomy.Transthoracic echocardiography revealed severe aortic insufficiency with a mobile valve vegetation, prompting surgical aortic valve replacement.He was initially anticoagulated with heparin, but developed heparin-induced thrombocytopenia with a persistently positive HIT antibody.He was treated for deep vein thrombosis with apixaban, which was bridged for surgery with argatroban infusion.The case proceeded with an intraoperative Flolan protocol to prevent HIT-associated thrombosis during heparin administration for cardiopulmonary bypass. The procedure was complicated by hypoxemia attributed to Flolan-associated pulmonary shunting.This case highlights the perioperative challenges in the setting of HIT and Flolan-associated hemodynamic instability."

Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Analysis of hemorrhagic transformation and intracerebral hemorrhage under combination therapy with alteplase and antiplatelets or anticoagulants, using the Japanese Adverse Drug Event Report database. (PubMed, PLoS One) - "HT and/or ICH signals were detected in patients receiving alteplase in combination with aspirin, P2Y12 inhibitors, cilostazol, ozagrel sodium, direct oral anticoagulants, warfarin potassium, heparin group, or argatroban. The findings from this study may help in understanding the risk of HT and ICH induced by rtPA in patients taking antiplatelet or anticoagulant medications, as well as in promoting the appropriate use of rtPA. Further prospective observational studies and randomized controlled trials are needed to assess these finding."

Adverse events • Journal • Cardiovascular • Cerebral Hemorrhage • Diabetes • Hematological Disorders • Hypertension • Ischemic stroke • Metabolic Disorders • Thrombosis

Unilateral Erector Spinae Plane Block for Thoracostomy Pain in Patient on Venovenous Extracorporeal Membrane Oxygenation (ASA 2025) - "A left-sided erector spinae plane catheter was placed with immediate and sustained improvement in pain scores. The catheter remained in for 60 hours without complication with patient systemically anticoagulated with argatroban for ECMO."

Clinical • Infectious Disease • Influenza • Pain • Pneumonia • Respiratory Diseases

Intravenous Argatroban or Eptifibatide in Patients Undergoing Mechanical Thrombectomy: A Subgroup Analysis of the MOST Randomized Clinical Trial. (PubMed, JAMA Neurol) - P3 | "Future investigations of these agents as intravenous adjuncts to thrombectomy should focus on populations who are ineligible for intravenous thrombolysis. ClinicalTrials.gov Identifier: NCT03735979."

Clinical • Journal • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke

Evaluating the Effectiveness of a Pharmacist-Driven Warfarin Consult Service Versus Physician Management in a Tertiary Community Hospital. (PubMed, J Pharm Technol) - "Exclusion criteria included an elevated international normalized ratio (INR) upon admission, argatroban use, active cancer, or warfarin ordered by both managing services. Overall, there was not a significant difference found in patient outcomes when comparing pharmacist versus physician warfarin management. Future studies with a larger sample size are needed to explore the potential differences in dosing regimens and its effect on the rate of significant INR elevations."

Journal • Oncology

Unexplained Platelet Aggregation Requiring Argatroban and Cangrelor During Carotid Endarterectomy (ASA 2025) - "We present a case of repeated intraoperative carotid artery platelet aggregation in a patient with undiagnosed essential thrombocytosis after patch angioplasty despite anticoagulation with heparin, ultimately requiring initiation of argatroban and cangrelor. Our case demonstrates a unique pathogenesis of repeated acute platelet aggregation in the setting of an undiagnosed hematological disorder despite standard anticoagulation protocol, highlighting the importance of having an alternative, protocolized anticoagulation plan that incorporates direct thrombin inhibitors and antiplatelet agents."

Anesthesia • Cardiovascular • Essential Thrombocythemia • Hematological Disorders • Thrombocytosis

Critical Use of POCUS to Uncover a Case of Cardiac Tamponade Post-Intubation (ASA 2025) - "A 78-year-old male with hypertension, type II diabetes, and heparin-induced thrombocytopenia (on Argatroban) was admitted after femoral artery laceration during elective hip replacement...Emergent pericardiocentesis withdrew blood-tinged fluid. The patient was transferred to the OR, where a pericardial window drained 700 mL of dark blood, resulting in normalization of cardiac function."

Clinical • Intubation • Cardiovascular • Diabetes • Hematological Disorders • Hypertension • Metabolic Disorders • Orthopedics • Thrombocytopenia • Type 2 Diabetes Mellitus

Revisiting Heparin-Induced Thrombocytopenia Among Patients Undergoing Free Tissue Transfer: A Systematic Review. (PubMed, J Reconstr Microsurg) - "Argatroban (26.1%) was the most frequently used alternative anticoagulant, while warfarin (30.4%) was the most common discharge medication. Although no single anticoagulation strategy demonstrated superior outcomes, expeditious diagnosis and treatment may improve flap salvage rates. This review provides a foundation for developing standardized protocols for HIT management in microsurgical patients."

Journal • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Anticoagulation Considerations during Left Atrial Appendage Occlusion: Argatroban for a Patient with ESRD and prior Heparin-Induced Thrombocytopenia (ASA 2025) - "When started, the argatroban infusion had a supratherapeutic response that remained elevated over an hour after the procedure's conclusion. This case demonstrates that argatroban can be administered safely for intraoperative anticoagulation in LAAO but requires vigilant monitoring and careful dose titration."

Clinical • Hematological Disorders • Nephrology • Renal Disease • Thrombocytopenia

Efficacy of argatroban plus alteplase according to time from onset to thrombolysis in acute ischemic stroke: a prespecified post-hoc analysis of the ARAIS trial. (PubMed, Front Neurol) - P4 | "The prespecified secondary analysis indicated that the efficacy of argatroban plus alteplase did not differ according to OTT in terms of achieving 90-day excellent functional outcomes compared with alteplase alone. ClinicalTrials.gov, Identifier: NCT03740958."

Journal • Retrospective data • Cardiovascular • Ischemic stroke

Anticoagulation for heparin-induced thrombocytopenia before, during, and after peripheral endovascular procedures. (PubMed, Vasa) - "Current evidence may support the use of bivalirudin among non-heparin anticoagulants for peripheral endovascular interventions due to indirect evidence of its use during percutaneous coronary intervention in patients with acute HIT...This leaves argatroban as the main alternative, particularly in patients with renal impairment...In the absence of robust evidence, anticoagulation strategies should be individualized and patients adequately informed. Further studies are necessary to optimize anticoagulant management among patients with HIT undergoing peripheral endovascular interventions."

Journal • Review • Hematological Disorders • Renal Disease • Thrombocytopenia

Antithrombin regulates neutrophil activities through the stimulation of C-type lectin family 1A. (PubMed, Blood Vessel Thromb Hemost) - "Recombinant as well as native AT concentration-dependently induced the rounding of purified human neutrophils in shape, associated with the suppression of spontaneous reactive oxygen species production in vitro, but argatroban did not, indicating the independence of AT effects on thrombin inhibition...The cellular effects of AT were similar to those of histidine-rich glycoprotein, which has the same CLEC1A as a receptor, and were partially inhibited by the addition of anti-CLEC1A antibody to the incubation media. These results suggested that CLEC1A is a novel receptor for AT, and the stimulation of CLEC1A by AT at least in part mediates the important functional changes of human neutrophils."

Journal • SERPINA6

Outcomes of Patients with Suspected Heparin-Induced Thrombocytopenia in a Contemporary Multicenter Cohort. (PubMed, Blood Adv) - "HIT, as well as the mere suspicion of HIT, remains a serious condition with a high risk of adverse outcomes, including death. Our findings provide further evidence supporting the effectiveness of DOACs, argatroban, and bivalirudin in reducing arterial thromboembolism risk."

Journal • Cardiovascular • Critical care • Hematological Disorders • Thrombocytopenia • Venous Thromboembolism

Low-molecular-weight heparin-induced thrombocytopenia with multisite embolism: successful management with argatroban and dabigatran - a case report and literature review. (PubMed, Front Pharmacol) - "Once HIT is diagnosed, all forms of heparin should be discontinued immediately, and the decision to administer platelet transfusion should be made with caution to prevent exacerbation of thrombosis. This study provides valuable insights into the early recognition and optimal management of LMWH-induced HIT."

Journal • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis

Catastrophic asparaginase-induced cerebral and systemic thrombosis in a young female with T-cell lymphoblastic lymphoma: A case report & literature review. (PubMed, Leuk Res Rep) - "Despite prophylactic anticoagulation, the patient developed extensive cerebral venous sinus thrombosis, deep vein thrombosis, and pulmonary embolism, necessitating mechanical thrombectomy, Argatroban therapy, and long-term anticoagulation. This case underscores the multifactorial pathophysiology of asparaginase-associated thrombosis and highlights the need for individualized risk assessment, vigilant monitoring, and dynamic anticoagulation strategies. A comprehensive literature review is provided to contextualize the epidemiology, mechanisms, risk factors, prevention, and management of this life-threatening complication, with practical recommendations for optimizing care in high-risk patients."

Journal • Acute Lymphocytic Leukemia • Cardiovascular • Hematological Disorders • Hematological Malignancies • Leukemia • Lymphoma • Oncology • Pulmonary Embolism • Respiratory Diseases • Thrombosis • Venous Thromboembolism

Dosing Reliability of Direct Thrombin Inhibitors in Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis. (PubMed, ASAIO J) - "A total of 28 studies were identified, most of which (n = 25) used bivalirudin, while the rest (n = 3) used argatroban. Sensitivity analysis confirmed robustness of the primary findings in only low-risk of bias studies and in only studies published as full papers. In summary, DTIs-specifically bivalirudin-were associated with faster time to therapeutic anticoagulation and maintained the goal range for a greater percentage of time than heparin during ECMO support."

Journal • Retrospective data • Pediatrics

Fondaparinux Failure in Heparin-Induced Thrombocytopenia With Acute Limb Ischemia: A Case Report and Literature Review. (PubMed, Cureus) - "The patient was transitioned to argatroban postoperatively, resulting in rapid platelet recovery and clinical improvement. Our case highlights the limitations of fondaparinux in select HIT cases, particularly when aHIT is suspected, and underscores the need for vigilance in monitoring for treatment failure. This report adds to emerging data on alternative anticoagulation strategies for refractory HIT, including the potential role of direct thrombin inhibitors in severe cases."

Journal • Cardiovascular • Hematological Disorders • Immunology • Lung Cancer • Oncology • Small Cell Lung Cancer • Solid Tumor • Thrombocytopenia • Thrombosis