Lepirudin Alteplase

Concomitant use with thrombolytic therapy Clinical trials in HIT patients have provided only limited information on the combined use of lepirudin and thrombolytic agents. The following dosage regimen of lepirudin was used in 9 HIT patients in the studies who presented with TECs at baseline and were started on both lepirudin and thrombolytic therapy (alteplase, urokinase, or streptokinase). 

Intracranial bleeding Following concomitant thrombolytic therapy with alteplase (tPA) or streptokinase may be life-threatening. Carefully assess the risk of lepirudin administration vs its anticipated benefit in patients with increased risk of bleeding. In particular, this includes the following conditions ... 

HIRUDINS THROMBOLYTICS t risk of bleeding complications when alteplase or streptokinase is co administered with lepirudin Additive effect on clotting cascade Watch for bleeding complications. Risk-benefit analysis is needed before co-administering this will involve availability of alternative therapies such as primary angioplasty... 

The manufacturers of lepirudin say that no formal interaction studies have been done but they reasonably warn that the concurrent use of lepirudin and other thrombolytics (they name alteplase and streptokinase) may increase the risk of Isleeding complications and considerably enhance the effect of lepirudin on the aPTT. They also warn about the increased risks of bleeding if antiplatelet drugs such as ciopidogrei, ticlopidine, abciximab, eptifibatide or tirofiban are used concurrently... 

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See also in sourсe #XX -- [ ]

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