Thrombocytopenia lepirudin

Thrombocytopenia with a positive in vitro test for antiplatelet antibodies in the presence of fondaparinux Lepirudin... 

Refludan Lepirudin Hoechst Marion Roussel Heparin-induced thrombocytopenia type II... 

Prophylaxis -can be used in heparin-induced thrombocytopenia Lepirudin 0.1 mg/kg/hr... 

Lepirudin is a recombinant derivative of hirudin (direct thrombin inhibitor secreted by salivary glands of leech). It inhibits thrombin directly and is mainly used in heparin induced thrombocytopenia. 

F. Role in therapy Lepirudin is a thrombin-inhibitor indicated for use in the treatment of adults with heparin-induced thrombocytopenia (HIT) type II diagnosis... 

Manfredi JA, Wall RP Sane DC, et al. Lepirudin as a safe alternative for effective anticoagulation in patients with known heparin-induced thrombocytopenia undergoing percutaneous coronary intervention case reports. Catheter Cardiovasc Interv 2001 52 468 -72. 

Greinacher A, Volpel H, Janssens U, et al. Recombinant hirudin (Lepirudin) provides safe and effective anticoagulation in patients with heparin-induced thrombocytopenia. A prospective study. Circulation 1999 99 73-80. 

Greinacher A, Lubenow N, Eichler R Anaphylactic and anaphylactoid reactions associated with lepirudin in patients with heparin-induced thrombocytopenia. Circulation 2003 108 2062-2065. 

Lubenow N, Eichler R Lietz T, et al, Lepirudin for prophylaxis of thrombosis in patients with acute isolated heparin-induced thrombocytopenia an analysis of three prospective studies, Blood 2004 104 3072-3077. 

Cochran K, DeMartini TJ, Lewis BE, et al. Use of lepirudin during percutaneous vascular interventions in patients with heparin-induced thrombocytopenia. J Invas Cardiol 2003 15 617-621. 

Refludan Lepirudin Berlex Laboratories 3/1998 Heparin-induced thrombocytopenia NA... 

Eichler P, Friesen HJ, Lubenow N, Jaeger B, Greinacher A. Antihirudin antibodies in patients with heparin-induced thrombocytopenia treated with lepirudin incidence, effects on aPTT, and clinical relevance. Blood 2000 96(7) 2373-8. 

From the therapeutic point of view, prophylaxis of thrombosis must be continued after withdrawal of heparin, since even when there is no evidence of thrombosis in association with heparin-induced thrombocytopenia, thrombosis can follow after some days (52). Because of cross-reactivity, low molecular weight heparin should not be used when heparin has been withdrawn because of heparin-induced thrombocytopenia nor should warfarin be used, because of the risk of venous gangrene, at least until the thrombocytopenia has resolved. Patients with life-threatening or limb-threatening thrombosis can be treated with thrombolytic drugs. Current views are that two antithrombotic drugs should be used, for example danaparoid plus lepirudin (58). 

Platelet counts should be carefully monitored for any decline. If thrombocytopenia develops, the time course and severity should help differentiate which type of HIT exists. If HIT I is suspected, heparin may be continued with caution. If HIT II is suspected, heparin therapy should be discontinued and an alternate form of anticoagulation therapy begun. If a low platelet count is encountered with a thrombotic complication, heparin should be discontinued immediately. Thrombolytic therapy or embolectomy may be necessary. Lepirudin (recombinant hirudin) is... 

In the case of heparin-induced thrombocytopenia with thrombosis, all forms of heparin must be discontinued, including heparin flushes, and anticoagulation with argatroban or the recombinant hirudin lepirudin initiated.These agents should also be considered for the treatment of patients who have acute heparin-induced thrombocytopenia without thombosis because of the increased risk... 

Lepirudin is a thrombin inhibitor. One molecule of lepirudin (rDNA) binds to 1 molecule of thrombin and blocks the thrombogenic activity of thrombin. It is indicated in anticoagulation in patients with heparin-induced thrombocytopenia and associated thromboembolic disease to prevent further thromboembolic complications. 

ARGATROBAN Argatroban, a synthetic compound based on the structure of L-Arg, binds reversibly to the catalytic site of thrombin. Administered intravenously, it has an immediate onset of action and a t j of 40-50 minutes. Argatroban is metabolized by hepatic CYPs and is excreted in the bile therefore dosage reduction is required for patients with hepatic insufficiency. The dosage is adjusted to maintain an aPTT of 1.5-3 times the baseline value. Argatroban can be used as an alternative to lepirudin for prophylaxis or treatment of patients with or at risk of developing heparin-induced thrombocytopenia. 

Lepirudin is used for treatment of patients who have thrombosis and thrombocytopenia as a result of an antibody-mediated reaction to heparin (see below). Antithrombin III is used for treatment of patients who need anticoagulation but are resistant to heparin because of a genetic deficiency in antithrombin III and also in some cases of acquired antithrombin III deficiency (eg, disseminated intravascular coagulation). 

Hirudin (lepirudin). Protein from the head and gullet rings of the medicinal leech (Hirudo medicinalis) (ca. 3 mg/leech). H is a heparinoid that delays blood coagulation (thrombin inhibitor). The Mr of H. is ca. 9060 (other reports 10800), it has a high content of acidic amino acid residues. H. is a colorless powder, soluble in water, insoluble in ethanol. The anticoagu-lati ve activity of H. is based on the formation of a compound with Aromhin, so that the latter cannot exert its catalytic effect Commercially available for use in the treatment of thrombosis, hematomas, etc. In Europe, recombinant H. (Refludan ) is marketed for heparin-associated thrombocytopenia. 

Hematologic Thrombocytopenia has been attributed to lepirudin in a 61-year-old... 

Walter KN, Erlacher M, Uhl M, Budde U, Nowak G, Superti-Furga A, Zieger B. Lepirudin treatment in a girl with iliac vein thrombosis, severe pulmonary embolism and suspected heparin-induced thrombocytopenia (HIT) n. Klin Padiatr 2009 221(3) 174-5. 

Tschudi M, Lammle B, Alberio L. Dosing lepirudin in patients with heparin-induced thrombocytopenia and normal or impaired renal function a single-center experience with 68 patients. Blood 2009 113(11) 2402-9. 

Petros S. Lepirudin in the management of patients with heparin-induced thrombocytopenia. Biologies 2008 2(3) 481-90. 

Schroeder WS, Tran MT, Gandhi PJ. Lepirudin-induced thrombocytopenia following subcutaneous administration. Am J Health Syst Pharm 2009 66(9) 834-7. 

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