argatroban / Generic mfg. - LARVOL DELTA

When pregnancy, HIT, and stroke collide: Navigating complex thrombotic care in a community-based setting (ASH 2025) - "Case Presentation: A 30-year-old woman, gravida 1 para 0, with a history of unprovoked lower extremity deep vein thrombosis (DVT) on chronic rivaroxaban for secondary prophylaxis was transitioned to low-molecular-weight heparin (enoxaparin) upon confirmation of pregnancy at 7 weeks' gestation...Enoxaparin was discontinued, and argatroban was initiated post-EVT, later transitioning to subcutaneous danaparoid, and ultimately fondaparinux for the remainder of her pregnancy...Another important feature of this case is that it was successfully managed entirely within a regional community hospital system, allowing the patient to stay close to her family and access local rehabilitation services. This case report highlights the ability of community-based hospitals to provide high-acuity, patient-centered care through strong interdisciplinary collaboration."

Cardiovascular • Hematological Disorders • Infectious Disease • Novel Coronavirus Disease • Thrombocytopenia • Thrombosis

Platelet dynamics and clinical outcomes in patients with heparin-induced thrombocytopenia – single center experience (ASH 2025) - "Several agents, such as bivalirudin, argatroban, danaparoid, and fondaparinux, have been used for the treatment of HIT. The dynamics of platelet counts after diagnosis may be an important tool for assessing treatment efficacy. Despite treatment, the mortality rate in critically ill patients with HIT remains high."

Clinical • Clinical data • Cardiovascular • Hematological Disorders • Thrombocytopenia

Heparin-induced thrombocytopenia after percutaneous coronary intervention complicated by hemothorax and pulmonary thromboembolism: The scylla and charybdis of hematology (ASH 2025) - "Those with a confirmed diagnosis need to be started on therapeutic-dose anticoagulation with argatroban, danaparoid, bivalirudin, or fondaparinux. Our case highlights a unique case of HIT with both thrombosis and life-threatening bleeding post-PCI that precluded the use of both anticoagulation and antiplatelets, underscoring the complexity of care, need for a multidisciplinary approach, and individualization of treatment in such cases."

Cardiovascular • Cerebral Hemorrhage • Chronic Kidney Disease • Diabetes • Endocrine Disorders • Hematological Disorders • Hypertension • Metabolic Disorders • Nephrology • Pulmonary Embolism • Renal Disease • Respiratory Diseases • Thrombocytopenia

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..."

Acute Kidney Injury • Cerebral Hemorrhage • Chronic Kidney Disease • CNS Disorders • Congestive Heart Failure • Diabetes • Diabetic Nephropathy • Fibrosis • Gastroenterology • Genetic Disorders • Heart Failure • Hematological Disorders • Hepatology • Immunology • Ischemic stroke • Liver Cirrhosis • Metabolic Disorders • Myocardial Infarction • Nephrology • Obesity • Pulmonary Embolism • Renal Disease • Respiratory Diseases • Thrombocytopenia

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

Efficacy and safety of adjunctive eptifibatide or argatroban versus control for acute ischemic stroke: A systematic review and network meta-analysis of randomized control trials (ASH 2025) - "Introduction: Acute ischemic stroke is a major cause of disability and mortality, with treatment mainlylimited to intravenous alteplase thrombolysis. Functional Independence (mRS 0-1): Eptifibatide showed superior odds versus control (OR 1.12 [0.65-1.95]) and Argatroban (OR 1.82 [0.61-5.45]), with wide confidence intervals. Argatroban versus controlyielded OR 1.05 [0.59-1.86], indicating uncertainty. Bayesian analysis showed minimal effect for Controlversus Argatroban = -0.046 [-0.65, 0.59], and slight advantage for Control versus Eptifibatide = 0.205 [-0.37, 0.78], with uncertainty."

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

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 • 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

Occurrence of Platelet-Monocyte Aggregates in Patients with Metabolic Disorders and Effect of Direct Anticoagulants. (PubMed, Thromb Haemost) - "Subsequently, blood samples were treated with four direct anticoagulants (rivaroxaban, apixaban, dabigatran, or argatroban, all at a final concentration of 1 µM), and PMA were again detected. Significant correlations of AP and PMA with anthropological and biochemical parameters were found solely in some groups of patients or in some anticoagulant-treated samples. Only argatroban and apixaban-treated samples significantly decreased PMA occurrence, and this was observed solely in the dyslipidemia patient group.These findings suggest a potential positive outcome of anticoagulant treatment for metabolic disease patients and confirm PMA as a sensitive marker in patients with metabolic diseases."

Journal • Cardiovascular • Diabetes • Dyslipidemia • Familial Hypercholesterolemia • Genetic Disorders • Metabolic Disorders • Type 1 Diabetes Mellitus • Type 2 Diabetes Mellitus • DMRT1

Alternative Anticoagulation for Patients with Heparin-Induced Thrombocytopenia on ECMO: A Narrative Review. (PubMed, Biomedicines) - "Most available data, primarily from retrospective studies, describe the use of argatroban in ECMO patients with HIT. Bivalirudin has also been used as an alternative anticoagulant in this population, with no significant increase in bleeding or thrombotic complications...Fondaparinux has shown effectiveness in the HIT setting and appears to have a low risk of complications. Factor XIIa inhibitors represent a novel class of anticoagulants currently under investigation, evaluated only in animal models. Growing clinical experience with alternative anticoagulants, particularly direct thrombin inhibitors, suggests that their use will likely become a primary focus in ECMO anticoagulation management in the coming years."

Journal • Review • Cardiovascular • Critical care • Hematological Disorders • Thrombocytopenia • Thrombosis

Argatroban for intraoperative anticoagulation in a patient with history of heparin-induced thrombocytopenia and end-stage renal disease undergoing left atrial appendage occlusion: a case report. (PubMed, Front Med (Lausanne)) - "This case demonstrates the effective use of argatroban as an intraoperative anticoagulant in LAAO for patients with HIT and renal impairment. A lower initial bolus and infusion rate may be sufficient with vigilant ACT monitoring to avoid complications of prolonged anticoagulation."

Journal • Anesthesia • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Hematological Disorders • Nephrology • Renal Disease • Thrombocytopenia

When HIT Testing Hurts- the Financial and Clinical Repercussions of Heparin Induced Thrombocytopenia Testing: A Single Center Analysis (ASH 2023) - "Changing to an alternate anticoagulant such as Argatroban increased costs by nearly $1,500 per case and this number increased further when adding the daily coagulation panel required while on this drug... This analysis examines the relative over-testing for HIT at a single institution. Compared with the known incidence of positive HIT tests, there is a significant number of positive HIT antibody tests at our hospital. The data further reveals a high probability of a false positive HIT antibody test results in the hospitalized patient, possibly due to immune reactivity."

Clinical • Cardiovascular • Gastrointestinal Disorder • Hematological Disorders • Thrombocytopenia • Venous Thromboembolism

Surviving Multiple Cardiac Arrests Secondary to Catastrophic Sero-Negative Antiphospholipid Syndrome: A Case Report (ASH 2023) - "Platelet count dropped while on heparin to 25,000 so a HIT panel was ordered and he was transitioned to argatroban...Given the potentially catastrophic effects of a missed CAPS diagnosis, a high level of clinical suspicion is needed as plasma exchange can quickly alleviate an otherwise disastrous condition. Further research into non-criteria APS autoantibodies (IgA)may be able to help guide future SNAPS diagnoses."

Case report • Clinical • Cardiovascular • Gastrointestinal Disorder • Genetic Disorders • Hematological Disorders • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Arthritis • Novel Coronavirus Disease • Pancreatitis • Pneumonia • Respiratory Diseases • Thrombosis • JAK2

Implementation of 4T Score Documentation on PF4 Testing in Patients with Suspected Heparin-Induced Thrombocytopenia (ASH 2023) - "Implementation of mandatory 4T score documentation significantly reduced PF4 orders and improved HIT diagnostic testing in a non-profit health system. Challenges remain with SRA turnaround time and corresponding duration of argatroban therapy. The results of this project have demonstrated that standardized documentation is essential for optimizing HIT diagnosis and management protocols."

Clinical • Hematological Disorders • Immunology • 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

Management of Refractory Heparin-Induced Thrombocytopenia with Ivig, Plasma Exchange, and Rituximab: A Case Report (ASH 2024) - "Argatroban was started, and thrombectomy of her lower extremity was performed...IVIg was initiated for 3 days, and AC was transitioned to bivalirudin...Additional research into the pathophysiology and management of this entity is needed.Conclusion : There are no current guidelines for treating severe refractory HIT. Further investigation is necessary to assess the role of autoimmunity and immunosuppression in managing this life-threatening condition."

Case report • Clinical • Cardiovascular • Hematological Disorders • Thrombocytopenia

Platelet Endoplasmic Reticulum Stress Promotes Thrombosis in an in Vitro Laser-Induced Endothelial Injury Model (ASH 2024) - "To examine the effects of anticoagulants in our endothelialized device, whole blood was treated with heparin (0.5 U/mL) or thrombin inhibitor argatroban (0.5 μg/mL)...Activation of IRE1 increased calcium mobilization in the platelets and thrombus formation. The above introduce the novel concept of ER stress-dependent calcium mobilization in vascular thrombosis."

Preclinical • Cardiovascular • Hematological Disorders • Thrombosis • ANXA5 • ERN1 • ITGA2B

Phase 1, 3-Sequence Interaction Study of Intravenous Vlx-1005 and Argatroban Shows a Favorable Safety, Pharmacokinetic and Pharmacodynamic Profile in Healthy Volunteers (ASH 2024) - "The coadministration of VLX-1005 with argatroban had no impact on the effect of argatroban on aPTT in healthy human adult subjects. The Phase 2 ALATHEA (A study of VLX-1005 to evaLuAte Thrombocyte change in HEpArin Induced Thrombocytopenia) study of VLX-1005 in HIT is currently ongoing."

Clinical • P1 data • PK/PD data • Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis • ALOX15

Impact of Rapid Latex Immunoassay (LIA) Implementation on Management of Heparin Induced Thrombocytopenia (HIT): A Retrospective Single Institution Study (ASH 2024) - "ELISA+ patients were switched to Argatroban (12), Bivalrudin (5), Apixaban (7) or no therapy (3). However, despite the shorter TAT of the LIA, the time to react and switch anticoagulation in LIA-positive patients was delayed. Incorporating RIs into HIT algorithms and increasing clinician awareness of the rapid TAT of RIs is warranted."

Retrospective data • Cerebral Hemorrhage • CNS Disorders • Gastrointestinal Disorder • Hematological Disorders • Thrombocytopenia

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