by Dr. Manura Nanayakkara

Created on: May 22, 2010   Last Updated: January 15, 2011

Acova is the popular brand name of the generic drug Argatroban. It is an anti coagulant, used for conditions like heparin induced thrombocytopenia and less commonly to treat myocardial infarction. It is a drug used by experienced doctors, in specialized centers. Acova is a synthetic piperidinecarboxylic acid derivative of l-arginine

 Acova is only available in injection form. It is administered as an intravenous infusion. In addition Acova is contraindicated in patients with active major bleeding, because it stops clot formation. Acova is also contraindicated in allergy to any part of the drug formulation.

 Acova should be used with cautiously in diseases or circumstances where there is an increased risk of bleeding. Examples would be severe hypertension, spinal anesthesia, following major surgery, gastrointestinal ulceration, and bleeding disorders.  Before starting this drug, all other intravenous anti coagulants should be discontinued. After that a test called aPTT should be done in heparin induced thrombocytopenia.

 Hemorrhage can occur in any site of the body, in patients who take acova. So doctors repeatedly check blood pressure and blood counts in patients. Over dosage should be managed in an intensive care setup, because there is no antidote available. Adverse hemorrhagic complications that occur with drug include gastro intestinal bleeding (vomiting blood, black/red color stools), hematuria, and coughing up blood.

 Sensitivity reactions

 Sensitivity reactions are common. Sometimes life threatening anaphylactic reactions can occur. Features suggesting anaphylactic reaction are chest tightness, wide spread hives, breatging difficulty and pallor. If you got above features then you should go to an medical emergency department.

 Non hemorrhagic side effects

 Difficulty in breathing, low blood pressure, fever, diarrhea, nausea, vomiting, and abdominal pain can occur with some patients. In addition cardiac arrest has been reported with some patients on Acova. Cardiac rhythm abnormalities like ventricular tachycardia and atrial fibrillation has reported in some patients. Increased incidence of infections like sepsis, urinary tract infections, and pneumonia reported with some patients. Cerebrovascular disorders such as stroke have also reported. Abnormal renal function has also reported in patients taking acova.

Some patients who are undergoing percutaneous coronary interventions have reported chest pain, back pain, headache, reduced heart rate, and myocardial infarction. Acova should not be used in pregnancy and lactation. It can use in adults less than 18 years of age but effectiveness or safety is not established by clinical trials. In addition dosage reduction is necessary in liver diseases.

 Drug interactions are mainly with other anticoagulants. Heparin should not be used with acova. Warfarin can also be given but with caution. However, aspirin and acetaminophen can be used safely with acova.

 Sources

 AHFS Drug information 2008

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