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Argatroban protocol

Discussion in 'Pharmacy' started by per protocol, Mar 22, 2007.

  1. per protocol

    per protocol Junior Member 2+ Year Member

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    Jun 17, 2006
    California
    Does any one work for hospital that has Argatroban monitoring protocol.
    We normally use Refludan, put pt. has renal failure and doctor wants to use Argatroban. I am looking for info on how to adjust it, rate, etc.
     
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  3. All4MyDaughter

    All4MyDaughter SDN Mommystrator Pharmacist Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    May 7, 2005
    Ivory Tower
    I know nothing about this drug. But I looked it up on lexi-comp and it says no adjustment needed for renal failure.

    <<<Dosage adjustment in renal impairment: Removal during hemodialysis and continuous venovenous hemofiltration is clinically insignificant. No dosage adjustment required.>>>

    Hepatic impairment is another story.
     
  4. per protocol

    per protocol Junior Member 2+ Year Member

    57
    0
    Jun 17, 2006
    California
    I need an info on adjusting Argatroban rate to get goal aptt. For example aptt is 30s how much to increse rate by to get 50s., not actual case just giving it for example- if you get the idea. This is for Heparin Induced Thrombocytopenia.
     
  5. All4MyDaughter

    All4MyDaughter SDN Mommystrator Pharmacist Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    May 7, 2005
    Ivory Tower
    Does your school-use lexi-comp?

    I don't know what this means but here ya go:

    <<<Initial dose: 2 mcg/kg/minute

    Maintenance dose: Measure aPTT after 2 hours, adjust dose until the steady-state aPTT is 1.5-3.0 times the initial baseline value, not exceeding 100 seconds; dosage should not exceed 10 mcg/kg/minute>>>
     
  6. npage148

    npage148 Senior Member PhD Pharmacist 10+ Year Member

    2,017
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    May 2, 2005
    Us
    just use arixtra and be done with it. No monitoring and a nice sc injection!
     
  7. sdn1977

    sdn1977 Senior Member 10+ Year Member

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    Jul 28, 2005
    Altho we don't use it where I work, look up the Mass General Protocol (I think they have one - I think I saw it in a study.)

    With renal failure, it becomes significant when the RF is moderate-severe - enough to affect plasma proteins, extravascular compartments, etc...

    I think they use something close to this:

    PTT<39 increase baseline rate by 40%
    PTT<40-49 increase baseline by 20%
    PTT 50-70 no change
    PTT 71-84 decrease by 20%

    But....with all these, particularly with comorbid conditions, its difficult to develop a defined protocol when there is just one physician &/or one or two patients. It helps if the physician writes the specific parameters he/she is comfortable with unless it becomes a formulary drug.

    Will this be your formulary drug or is this just a one-time thing?

    The drug has only been published in a handful of rf pts (altho probably used in lots more than published)..but these folks are followed closely since their extracellular vd can change dramatically & this is where the drug is located.
     
  8. DrugDealer

    DrugDealer Senior Member 5+ Year Member


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