What is the effect on International Normalized Ratio (INR)?
Because Argatroban is a direct thrombin inhibitor, coadministration of Argatroban and warfarin produces a combined effect on the laboratory measurement of the INR.[4] However, concurrent therapy, compared to warfarin monotherapy, exerts no additional effect on vitamin K-dependent factor Xa activity. The relationship between the INR on cotherapy and warfarin alone is dependent on both the dose of Argatroban and the thromboplastin reagent used. This relationship is influenced by the International Sensitivity Index (ISI) of the thromboplastin. Data for two commonly utilized thromboplastins with ISI values of 0.88 (Innovin, Dade) and 1.78 (Thromboplastin C Plus, Dade) are presented in Figure 6 for a dose of Argatroban of 2 mcg/kg/min. In general, with doses up to 2 mcg/kg/min, for thromboplastins with ISI values between 0.88 and 2.0 when the INR on combination therapy is >4, the INR on warfarin alone will be within the target range.[2,26] Thromboplastins with higher ISI values than shown r
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