The direct thrombin inhibitor argatroban: a review of its use in patients with and without HIT

Argatroban is a synthetic direct thrombin inhibitor with a relative short elimination half-life of 45 minutes and elimination which is predominantly performed via hepatic metabolism. Argatroban anticoagulation has been systematically studied in patients exhibiting the heparin-induced thrombocytopenia (HIT)/thrombosis syndrome and demonstrated to be a safe and effective therapy in this indication. Moreover, in smaller studies argatroban has also been assessed in special clinical settings in non-HIT patients. The current review presents the pharmacology of argatroban, data regarding monitoring of the agent, and an overview of the results of the major clinical trials assessing argatroban anticoagulation in HIT patients. Additionally, data from clinical trials with argatroban use outside HIT, in more special indications such as in percutaneous coronary intervention, stroke, renal replacement therapy, and intensive care medicine, are reviewed.