Measuring argatroban concentration in plasma
This assay is not useful for measurement of other direct thrombin inhibitors eg, dabigatran or bivalirudin.
Chromogenic Assay
ARGATROBAN
Acova
Plasma Na Cit
This test measures argatroban only. For measurement of dabigatran direct thrombin inhibitor, see DABIE / Dabigatran, Ecarin, Plasma.
This test is not indicated for monitoring low molecular weight heparin (LMWH), unfractionated heparin (UFH), or oral direct anti-Xa inhibitors (eg, apixaban, rivaroxaban, edoxaban). For monitoring oral direct anti-Xa inhibitors, see APIXA / Apixaban, Anti-Xa, Plasma; EDOXA / Edoxaban, Anti-Xa, Plasma, or RIVAR / Rivaroxaban, Anti-Xa, Plasma.
If priority specimen, mark request form, give reason, and request a call-back.
Specimen Type: Platelet-poor plasma
Collection Container/Tube: Light-blue top (3.2% sodium citrate)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Specimen should be collected 2 hours after initiation of continuous infusion of argatroban.
2. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing in Special Instructions.
3. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.
4. Aliquot plasma into a plastic vial leaving 0.25 mL in the bottom of centrifuged vial.
5. Freeze plasma immediately (no longer than 4 hours after collection) at -20 degrees C or, ideally, < or =-40 degrees C.
Additional Information:
1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.
2. Each coagulation assay requested should have its own vial.
If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.
0.5 mL
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Plasma Na Cit | Frozen | 42 days |
Measuring argatroban concentration in plasma
This assay is not useful for measurement of other direct thrombin inhibitors eg, dabigatran or bivalirudin.
Argatroban, a parenteral direct thrombin inhibitor (DTI) that directly inhibits factor IIa, is indicated for use in patients with heparin-induced thrombocytopenia (HIT). Argatroban is administered via continuous infusion, is eliminated by the liver, and can inhibit both soluble and clot-bound thrombin. Argatroban effect is typically monitored using activated partial thromboplastin time (APTT) measurements with a target of 1.5 to 3.0 times the patient’s baseline value. However, in instances where patients have a prolonged baseline APTT (eg, lupus anticoagulants and factor XII deficiency), APTT monitoring of argatroban is not reliable and measurement of argatroban's effect on factor IIa may be more reliable.
There are no clinical studies directly correlating argatroban concentration to clinical outcomes. The available data suggest that plasma concentrations of argatroban 1.2 to 2.3 mcg/mL correspond to an APTT ratio of 1.5 to 3.0.(1)
<0.10 mcg/mL
Therapeutic reference ranges have not been established. See Clinical Information for activated partial thromboplastin time correlative information.
Routine monitoring of argatroban drug levels is not indicated, the recommended monitoring per product guidelines is with the activated partial thromboplastin time.
Argatroban concentration may be affected by drug interactions, liver and renal disease.
Marked presence of lipemia or bilirubin in the sample could falsely decrease argatroban levels.
The lower limit of detection of this assay is 0.10 mcg/mL.
1. Ahmad S, Iqbal O, Ahsan A, et al: Clinical laboratory monitoring of a synthetic antithrombin agent, argatroban, using high performance liquid chromatography and functional methods. Int Angiol. 1999;18:198-205
2. Argatroban Injection. Package insert: Sandoz, Inc; 2019
3. Van Cott EM, Roberts AJ, Dager WE: Laboratory monitoring of parenteral direct thrombin inhibitors. Semin Thromb Hemost. 2017;43: 270-276
4. Gosselin RC, King JH, Janatpour KA, et al: Comparing direct thrombin inhibitors using aPTT, Ecarin clotting times, and thrombin inhibitor management testing. Ann Pharmacother. 2004;38:1383-1388
5. Gosselin RC, Adcock DM, Bates SM, et al: International Council for Standardization in Haematology (ICSH) recommendations for laboratory measurement of direct oral anticoagulants. Thromb Haemost. 2018 Mar;118(3):437-450
6. Lind SE, Boyle ME, Fisher S, Ishimoto J, Trujillo TC, Kiser TH: Comparison of the aPTT with alternative tests for monitoring direct trombin inhibitors in patient samples. Am J Clin Pathol. May 2014;141:665-674
7. Curvers J, van de Kerkhof D, Stroobants AK, van den Dool EJ, Scharnhorst V: Measuring direct thrombin inhibitors with routine and dedicated coagulation assays. Am J Clin Pathol. 2012;138: 551-558
8. Seidel H, Kolde HJ: Monitoring of argatroban and lepirudin: what is the input of laboratory values in "real life"? Clin Appl Thromb Hemost .2018 Mar;24(2):287-294
9. Fenyvesi T, Jorg I, Harenberg J: Monitoring of anticoagulant effects of direct thrombin inhibitors. Semin Thromb Hemost. 2002;28(4):361-368
The argatroban, ecarin chromogenic assay is performed on the Instrumentation Laboratory ACL TOP 700 using the Diagnostica Stago ECA II kit. The STA ECA II kit is a chromogenic assay based on the cleavage of prothrombin by ecarin to meizothrombin which then enzymatically cleaves the paranitroanaline (pNA) from the chromogenic substrate resulting in a measureable colorometric change.(Package insert: STA-ECA II. Diagnostica Stago S.A.S; Revision 09/2015)
Monday through Friday
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
80299
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
ARGAT | Argatroban, Ecarin, P | 55363-6 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
ARGA1 | Argatroban, Ecarin, P | 55363-6 |
ARGA2 | Interpretation | 69049-5 |
ARGA3 | Cautions | 62364-5 |