Argatroban for Percutaneous Coronary Interventions

ABSTRACT

Concomitant anticoagulant therapy is essential in patients undergoing percutaneous coronary interventions (PCI) to achieve prompt, early, complete, and sustained coronary artery recanalization. Heparin has been historically used in these procedures. Argatroban is a small-molecule, synthetic, reversible direct thrombin inhibitor. It has a predictable anticoagulant response and also the potential to inhibit clot-bound thrombin. The accessibility of argatroban to the active site of clot-bound thrombin is an advantage for the treatment of coronary occlusion. This is accomplished by virtue of the low molecular weight of argatroban (527 Da). Argatroban has been shown in clinical studies to be a safe and effective anticoagulant during PCI. It has received approval from the Food and Drug Administration for anticoagulation in patients with heparin-induced thrombocytopenia who require PCI. Other clinical studies have shown that argatroban, combined with the GP (glycoprotein) IIb/IIIa receptor inhibitors, can also be successfully used for anticoagulation in coronary interventional procedures. Clinical trials in the setting of PCI and related coronary interventional procedures are ongoing.

KEYWORDS

Antithrombin - argatroban - coronary intervention - recanalization - heparin-induced thrombocytopenia (HIT)

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