Use of lepirudin during percutaneous vascular interventions in patients with heparin-induced thrombocytopenia.
Research article published in The Journal of invasive cardiology (2003)
Abstract
UNLABELLED: Heparin-induced thrombocytopenia (HIT) is a well-known complication of heparin exposure and presents a clinical dilemma for patients undergoing percutaneous intervention (PI). Heparin cannot be used for thrombin inhibition and direct thrombin inhibitors offer an attractive alternative to heparin. We report our experience with lepirudin, a recombinant hirudin, used for PI in HIT patients. METHODS: Patients undergoing PI with known diagnosis of HIT were assigned to varying doses of lepirudin, often in combination with a platelet glycoprotein (GP) IIb/IIIa inhibitor. Predetermined endpoints of safety and efficacy were assessed prospectively. RESULTS: Twenty-five patients underwent a total of 36 interventions. Angiographic success was obtained in 100% of patients and clinical success (freedom from death, myocardial infarction, stroke or target vessel revascularization) in 92% of patients. There was 1 procedure-related mortality resulting from a retroperitoneal bleed. Three patients had minor bleeding. CONCLUSION: Lepirudin is efficacious as a replacement for heparin in patients with HIT undergoing PI. Caution should be used when using a combination of lepirudin, GP IIb/IIIa inhibitors, clopidogrel and aspirin.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Use of lepirudin during percutaneous vascular interventions in patients with heparin-induced thrombocytopenia.
Warum dies für die Hirudotherapie relevant ist
This prospective study reported experience using lepirudin (recombinant hirudin) as a heparin substitute in 25 patients with heparin-induced thrombocytopenia undergoing 36 percutaneous vascular interventions, frequently combined with GP IIb/IIIa inhibitors, achieving 100% angiographic success and 92% clinical success, with one procedure-related mortality from retroperitoneal hemorrhage and three minor bleeding events. Directly relevant to ASH as a clinical application of a leech-derived anticoagulant in interventional cardiology. Caveat: Small sample size without a concurrent control group, and the authors caution about bleeding risk when combining lepirudin with multiple antiplatelet agents; the study concerns pharmaceutical recombinant hirudin rather than live leech therapy.
Zitation
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