Exembol: anticoagulant licensed in heparin-induced thrombocytopenia

Exembol (argatroban) is now available in the UK for the treatment of thrombotic disorders in patients with heparin-induced thrombocytopenia.

Argatroban has a short half-life of around 50 minutes and must be given by continuous intravenous infusion
Argatroban has a short half-life of around 50 minutes and must be given by continuous intravenous infusion

PHARMACOLOGY

Argatroban is a parenteral direct thrombin inhibitor that binds reversibly to thrombin. It exerts its anticoagulant effect by inhibiting thrombin-mediated reactions including fibrin formation, platelet aggregation, and the activation of coagulation factors V, VIII and XIII and protein C.1

As argatroban is metabolised in the liver, it can be used patients with renal impairment. However, it is contraindicated in patients with severe hepatic impairment and those undergoing PCI who have any degree of hepatic impairment.1

CLINICAL STUDIES

Two open-label studies evaluated the efficacy and safety of argatroban in a total of 568 patients with heparin-induced thrombocytopenia type II (with or without thrombosis syndrome). Control data were taken from historical studies.2,3

Doses were given by continuous intravenous infusion and were titrated to achieve an activated partial thromboplastin time (aPTT) of 1.5–3 times the baseline aPTT, not exceeding 100 seconds.2,3

In the first study, incidence of the primary endpoint, a composite of new thrombosis and all-cause death or amputation, was significantly reduced in the argatroban group compared with control: 25.6% vs 38.8% (p=0.014). Similar results were observed in the second study.2,3

References:

  1. Exembol Summary of Product Characteristics, May 2011.
  2. Lewis BE et al. Circulation 2001; 103:1838–43.
  3. Lewis BE et al. Arch Intern Med 2003; 163:1849–56.

View Exembol drug record

Further information: Mitsubishi Pharma

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