Beyond activated partial thromboplastin time: viscoelastic monitoring of argatroban in the critically ill.

Abstract

Argatroban is increasingly used in critically ill patients, either for heparin-induced thrombocytopenia or as an alternative anticoagulant during extracorporeal support, yet its monitoring remains challenging. Schiferer and colleagues report that the ecarin clotting time measured with ClotPro® correlates strongly with plasma argatroban concentrations, whereas activated partial thromboplastin time (aPTT) shows little or no association, particularly above 55 s. Their important findings question the reliability of aPTT for argatroban titration in critically ill patients. Although the study supports implementation of viscoelastic argatroban monitoring, it also highlights the pressing need for outcome-driven validation of standardised therapeutic thresholds.