Iintroduction

The elimination of all heparin sources and the initiation of alternative anticoagulation are recommended for treating patients with heparin-induced thrombocy-topenia (HIT), whether or not complicated with thrombosis (Warkentin and Greinacher, 2004). Argatroban is the only direct thrombin inhibitor (DTI) approved in the United States as an anticoagulant for use in patients with HIT in both noninterventional and interventional settings. Two other DTIs are approved in the United States for use in patients with HIT in either the noninterventional (lepirudin; see Chapter 14) or interventional (bivalirudin, see Chapter 16) setting, but not both. Argatroban is indicated in the United States as an anticoagulant for prophylaxis or treatment of thrombosis in patients with HIT and for patients with, or at risk for, HIT undergoing percutaneous coronary intervention (PCI) (Argatroban Prescribing Information, U.S., 2002). It is also available in Austria, Canada, Denmark, Iceland, Germany, The Netherlands, Norway, and Sweden as an anticoagulant for patients with HIT.

In this chapter, the clinical pharmacology of argatroban is reviewed, together with its clinical utility as an anticoagulant in patients with or at risk for HIT. Historically, argatroban was initially known worldwide as "MD-805" and then under the trademark "Novastan." In 2000, the U.S. Food and Drug Administration disallowed the trademark Novastan in the United States because of potential similarities with other named products. Hence, argatroban (generic name) is marketed in the United States without a trademark and under the name "Arga-troban" (with a capital A). However, the trademark Novastan continues to be used in some countries, and the trademarks Argatra and Arganova have been introduced in some countries.

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