Q: Combination of Argatroban and Warfarin can give falsely very high
INR. What would be the best method to know that INR would be in therapeutic
range if Argatroban is discontinued?
Answer: Measurement
of chromogenic factor X level
The combination of argatroban and warfarin may
raise the INR falsely to value higher than even beyond 5.0. Measuring
chromogenic factor X level may help in smooth transition. Once level of
chromogenic factor X is below 40-45%, it typically indicates that the INR will
be therapeutic (2-3) when the argatroban is discontinued.
Reference:
Hursting MJ, Lewis BE, Macfarlane DE. (2005). "Transitioning
from argatroban to warfarin therapy in patients with heparin-induced
thrombocytopenia.". Clin Appl Thromb Hemost 11 (3): 279–87.
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