argatroban / Generic mfg. - LARVOL DELTA

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

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

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

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

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

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

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

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

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

Treatment of intraprocedural stent thrombosis with intracoronary argatroban injection in ST-segment elevation myocardial infarction. (PubMed, Cardiol J) - No abstract available

Journal • Cardiovascular • Hematological Disorders • Myocardial Infarction • Thrombosis

Left Ventricular Assist Device Implantation Under Argatroban Anticoagulation in Heparin-Induced Thrombocytopenia: A Literature Review and Clinical Case Presentation. (PubMed, J Clin Med) - "In this case, despite targeting an ACT above 400 s, intraoperative complications such as clot formation in the heart-lung machine and difficulty achieving hemostasis highlight the need for improved monitoring and dosing protocols. Our findings call for refined anticoagulation strategies and advanced monitoring techniques to optimize argatroban use in cardiac surgery, offering valuable insights for clinicians managing complex scenarios where conventional heparin therapy is contraindicated."

Journal • Review • Cardiovascular • Congestive Heart Failure • Heart Failure • Hematological Disorders • Thrombocytopenia • Transplantation

A Case of Surgery for a Giant Popliteal Venous Aneurysm Positive for Heparin-Induced Thrombocytopenia Antibodies with Repeated Acute Pulmonary Embolism. (PubMed, Ann Vasc Dis) - "Postoperatively, the popliteal vein showed shrinkage, and no recurrence of thromboembolism was observed. We report a case in which a patient with a PVA positive for HIT antibodies was successfully treated with PVA resection and anticoagulation therapy with argatroban."

Journal • Cardiovascular • Hematological Disorders • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia

Association Between Argatroban and Outcomes of Branch Atheromatous Disease: A Propensity-Matched Analysis From MRI-Based Study. (PubMed, CNS Neurosci Ther) - "Argatroban was not associated with excellent outcome at 90 days in patients with acute BAD-related stroke. Our study suggests that the risks and benefits of argatroban need reevaluation in patients with BAD-related stroke."

Journal • Atherosclerosis • Cardiovascular

Acquired Factor V Inhibitor following management of infective endocarditis (ISTH 2025) - "Argatroban was started for suspected HIT however HIT testing was negative and platelets recovered...Coagulation studies improved after three courses of plasma exchange and steroids. It was determined that her coagulopathy was due to an acquired FV inhibitor combined with vitamin K deficiency in the setting of gut microflora suppression due to prolonged antibiotic use."

Cardiovascular • Hematological Disorders • Immunology • Infectious Disease • Thrombocytopenia

Parallelism in PT-based one-stage extrinsic factor assays in patients receiving anticoagulants (ISTH 2025) - "Other than Factor II assays in presence of argatroban the majority of assays were parallel by either %CV or SR criteria.See table 1 and Figure 1. Table or Figure Upload"

Clinical

Vaccine-induced immune thrombotic thrombocytopenia (VITT)-like syndrome: a case report (ISTH 2025) - "Anti-PF4 immune thrombotic disorders were supposed and it was indicated to start argatroban in place of UFH therapy and to administer intravenous immune globulin (IVIG)...On the same blood sample, subsequent platelet activation assays did not demonstrate increased activation with the addition of heparin (HIPA assays) but showed an increased activation with the addition of PF4 (PIPA assays), thus defining a VITT-like syndrome. Table or Figure Upload"

Case report • Clinical • Cardiovascular • Hematological Disorders • Immunology • Infectious Disease • Influenza • Novel Coronavirus Disease • Pain • Renal Disease • Respiratory Diseases • Septic Shock • Thrombocytopenia • Venous Thromboembolism

Improved APTT correlation with anti-Xa and anti-IIa using heparin resistant recalcification (ISTH 2025) - "Methods Plasmas from 163 patients on heparin, mainly from extracorporeal membrane oxygenation (ECMO) procedures, including 16 also on argatroban, were tested using APTT with and without HRRS (AntiHepCaTM), chromogenic anti-factor Xa (AXA) and anti-thrombin (ATA) assays for heparin, and additional tests for factor VIII, fibrinogen, antithrombin, and C-reactive protein (CRP)...In 8% of cases, HRRS prolonged APTT, linked to low factor VIII levels. Table or Figure Upload"

CRP

VLX-1005 regulates Heparin-induced thrombocytopenia (HIT) through inhibition of 12-LOX independent of thrombin activation. (ISTH 2025) - "Platelets in whole blood under arterial shear were prevented from adhering to collagen in the presence of VLX-1005 but not argatroban. Mice treated with VLX-1005 had no bleeding diathesis in a HIT model and were observed to result in significantly fewer platelets being activation in vivo."

Cardiovascular • Hematological Disorders • Thrombocytopenia • Thrombosis • ALOX15

Heparin-Induced Thrombocytopenia in a Patient With Pulmonary Embolism and Bilateral Deep Venous Thrombosis: A Case Report. (PubMed, Cureus) - "A CT chest pulmonary angiogram revealed a positive for acute pulmonary artery embolus in the right lower lobar branch pulmonary artery. Vascular Laboratory (VL) left upper extremity duplex revealed acute occlusive deep venous thrombosis (DVT) of the left jugular, subclavian, axillary, and brachial veins and superficial vein thrombosis in basilic and cephalic veins. The patient received an IV heparin bolus and continued on heparin infusion. The Hematologist evaluated the patient and stated that the clinical findings were consistent with HIT. The HIP antibody (screening test) resulted positive, and the patient's optical density (O.D) was elevated to 0.536. Later on, the patient was noted to have right upper extremity swelling, and VL duplex upper extremity right veins showed acute occlusive DVT involving the right subclavian vein, axillary vein, brachial vein, and internal jugular vein, and a drop in platelet count to 54 K/μL. The..."

Journal • Cardiovascular • Hematological Disorders • Pulmonary Embolism • Respiratory Diseases • Thrombocytopenia • Thrombosis

Anesthetic considerations in Libman-Sacks endocarditis with severe valve involvement and superinfection in a patient with systemic Lupus Erythematosus: A Case Report (Euroanaesthesia 2025) - "Postoperatively, he required norepinephrine, milrinone, 2 units of RBC and protamine (28,000 IU)...He was extubated on postoperative day 1, received hydroxychloroquine and methylprednisolone, being discharged on day 7. LSE is commonly associated with malignancies, SLE, and antiphospholipid syndrome...In patients requiring ECC, UFH dosage should be adjusted based on ACT, or if contraindicated, bivalirudin or argatroban may be used. However, in APS patients with hypofibrinogenemia, ACT may be prolonged, leading to false positives, thus real-time viscoelastic testing is necessary for accurate monitoring [3]"

Case report • Clinical • Anesthesia • Cardiovascular • Genetic Disorders • Hepatology • Immunology • Inflammatory Arthritis • Lupus • Oncology • Renal Disease • Systemic Lupus Erythematosus

Perioperative anticoagulation management for a patient undergoing cardiac surgery with a history of Heparin Induced Thrombocytopenia (HIT): a case report (Euroanaesthesia 2025) - "Argatroban is recommended in patients with renal insufficiency due to its hepatic elimination, a half-life of 40 to 50 minutes and predictable dosing. Unlike bivalirudin whose elimination depends on creatinine clearance, having unstable dosing."

Case report • Clinical • Surgery • Acute Kidney Injury • Cardiovascular • Hematological Disorders • Immunology • Inflammatory Arthritis • Lupus • Nephrology • Renal Disease • Systemic Lupus Erythematosus • Thrombocytopenia • Thrombosis

Intraoperative anticoagulation in patients with Heparin-induced Thrombocytopenia type II undergoing vascular surgery (Euroanaesthesia 2025) - "Postoperative anticoagulation with fondaparinux was continued, and no HIT recurrence occurred. In patients with HIT requiring intraoperative anticoagulation, platelet count, anti-PF4 antibodies, and functional platelet testing are recommended. In all other cases, surgery should be delayed or alternative anticoagulants such as argatroban or bivalirudin should be used, plasmapheresis or heparin + antiplatelet agents might be considered. Based on institutional experience, argatroban was chosen for its short half-life, aPTT-guided monitoring, and hepatic metabolism, achieving stable intraoperative anticoagulation with favorable outcomes."

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

Heparin-Induced Thrombocytopenia in patients with circulatory support: literature review and case series (Euroanaesthesia 2025) - "Overall mortality was 53%, but lower in HIT patients (33%) versus non-HIT patients (57.1%), likely due to alternative anticoagulants like argatroban and bivalirudin. Early diagnosis and alternative anticoagulants are essential to minimize complications and improve outcomes. This study underscores the importance of tailored protocols to balance thrombotic and hemorrhagic risks in this critical population.Ref: Kato C, Oakes M, Kim M, et al.Anticoagulation strategies in extracorporeal circulatory devices in adult populations."

Clinical • Review • Cardiovascular • Hematological Disorders • Infectious Disease • Thrombocytopenia • Thrombosis

Experimental Evaluation of Drug Effects on Maintaining Transplanted Vascularized Adipose Tissue Volume Using an Axillary Fat Flap Model. (PubMed, J Craniofac Surg) - "Argatroban hydrate administered through nutrient vessels may improve the capillary density rate within the transplanted fat flap and sustain the volume of the transplanted vascularized adipose tissue through nutrient vessel administration. This axillary fat flap may be valuable for future research on vascularized adipose tissue transplantation."

Journal • Transplantation