Comparison of bivalirudin to lepirudin and argatroban in patients with heparin-induced thrombocytopenia
Research article published in American journal of health-system pharmacy (2015)
Abstract
OBJECTIVE: To evaluate the safety, effectiveness, and dosing of off-label bivalirudin to argatroban and lepirudin in patients with heparin-induced thrombocytopenia (HIT) using a new pharmacist driven protocol. METHODS: Retrospective cohort study of forty eight patients treated with lepirudin, argatroban, or bivalirudin from November 2010 to February 2012 for suspected HIT. Patients were excluded if the bivalirudin therapy was being used for acute coronary syndrome or if the treatment duration was less than 24 hours. The primary endpoint was time to therapeutic activated partial thromboplastin time (aPTT 50-90 seconds for argatroban and bivalirudin and 50-85 seconds for lepirudin). The secondary endpoints were elevation in international normalized ratio (INR), bleeding episodes, and percent time in aPTT target range. RESULTS: Patients receiving bivalirudin reached a therapeutic aPTT more quickly than those receiving argatroban and lepirudin (3.7 hours vs. 14.2 hours vs. 14.7 hours, p <0.001). The INR was increased more in patients treated with argatroban than lepirudin and bivalirudin (1.3 vs. 0.3 vs. 0.4, p = 0.4). Clinically significant bleeding in patients treated with bivalirudin was significantly lower than that observed with argatroban or lepirudin (7% vs. 22% vs. 56%, p = 0.02). The average percentage of therapeutic aPTTs drawn was higher for patients treated with bivalirudin than those patients treated with argatroban and lepirudin (90% vs. 66% vs. 67%, p = 0.2). CONCLUSION: A pharmacist-driven protocol for bivalirudin provided a significantly shorter time to therapeutic aPTT and lower bleeding rate for patients being treated for HIT when compared to lepirudin and argatroban. A larger study should be considered to confirm the results of this single center study.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Comparison of bivalirudin to lepirudin and argatroban in patients with heparin-induced thrombocytopenia.
Warum dies für die Hirudotherapie relevant ist
Diese Vergleichsstudie evaluierte die Sicherheit, Wirksamkeit und Dosierung von Bivalirudin gegenüber Argatroban und Lepirudin (einem rekombinanten Hirudin) bei Patienten mit Verdacht auf Heparin-induzierte Thrombozytopenie. Die Befunde zeigen, dass Bivalirudin eine signifikant kürzere Zeit bis zum therapeutischen aPTT und eine geringere Blutungsrate (7 %) im Vergleich zu Lepirudin (56 %) bot, was wertvolle Vergleichsdaten zu den klinischen Risiken von rekombinantem Hirudin liefert. Die Relevanz für die angewandte Hirudotherapie ist jedoch begrenzt, da die Forschung isolierte pharmazeutische Derivate bewertet, nicht lebende Blutegel oder rohe Blutegelsekrete. Darüber hinaus handelt es sich um eine Single-Center-Analyse mit einer begrenzten Stichprobe von 48 Patienten, was nach Angabe der Autoren größerer Studien zur Bestätigung bedarf.
Zitation
Comparison of bivalirudin to lepirudin and argatroban in patients with heparin-induced thrombocytopenia
Bain J et al. · American journal of health-system pharmacy, 2015
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