Monitoring of Argatroban and Lepirudin: What is the Input of Laboratory Values in Real Life?
Research article published in Clinical and applied thrombosis/hemostasis (2017)
Abstract
Monitoring of direct thrombin inhibitors (DTIs) in patients with heparin-induced thrombocytopenia (HIT) is primarily performed using the activated partial thromboplastin time (aPTT). This assay is poorly standardized, reagent dependent, and not DTI specific. We compared aPTT, thrombin time (TT), and prothrombin time (PT) to drug levels obtained by the ecarin chromogenic assay (ECA). We analyzed 495 samples of patients with confirmed or suspected HIT on treatment with either argatroban (n = 37) or lepirudin (n = 80). Mean DTI levels ± standard deviation (SD) were 0.41 ± 0.36 µg/mL for argatroban and 0.20 ± 0.21 µg/mL for lepirudin. Results of aPTT were highly variable: 67 ± 22 seconds for argatroban and 55 ± 20 seconds for lepirudin. Significant correlations ( P < .01) were found between ECA-based DTI level and TT (argatroban, r = .820 and lepirudin, r = .830), PT (argatroban, r = -.544), and aPTT (lepirudin, r = .572). However, there was no correlation of aPTT with argatroban or PT with lepirudin concentration. Multiple regression analyses revealed that the TT predicted 54% of argatroban and 42% of lepirudin levels, but no significant impact was seen for PT or aPTT. The aPTT-guided monitoring of DTI therapy leads to a high percentage of patients with inaccurate plasma levels, hence resulting to either undertreatment or overtreatment. Knowledge of baseline values prior to DTI therapy and inclusion of clinical settings are essential for dosing DTIs when using aPTT. However, due to several limitations of aPTT, monitoring according to exact plasma concentrations as obtained by specific tests such as ECA may be more appropriate.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Monitoring of Argatroban and Lepirudin: What is the Input of Laboratory Values in Real Life?.
Por qué esto importa para la hirudoterapia
Este estudio comparó el TTPa, el tiempo de trombina (TT) y el tiempo de protrombina (TP) frente a las concentraciones farmacológicas basadas en el ensayo cromogénico de ecarina (ECA) en 495 muestras de pacientes con HIT confirmada o sospechada tratados con argatrobán (n=37) o lepirudina (n=80). Los autores encontraron que el TTPa se correlacionó escasamente con la concentración plasmática de lepirudina (r=0,572) y que el TT predijo solo el 42 % de los niveles de lepirudina, concluyendo que el monitoreo guiado por el TTPa conduce a niveles plasmáticos inexactos y que el monitoreo de concentración basado en ECA podría ser más apropiado. Advertencia: el resumen no describe el origen de la lepirudina ni su relación con la hirudina derivada de sanguijuelas; no se puede establecer un vínculo defendible con la hirudoterapia, la hirudoterapia con sanguijuelas vivas ni el secretoma de la sanguijuela a partir de este resumen por sí solo. El estudio concierne al monitoreo de laboratorio de inhibidores directos de la trombina, y cualquier relevancia para el dominio de ASH es, en el mejor de los casos, indirecta.
Citación
Monitoring of Argatroban and Lepirudin: What is the Input of Laboratory Values in Real Life?
Seidel H et al. · Clinical and applied thrombosis/hemostasis, 2017
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026