American Society of Hirudotherapy

Lepirudin for prophylaxis of thrombosis in patients with acute isolated heparin-induced thrombocytopenia: an analysis of 3 prospective studies.

Research article published in Blood (2004)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Clinical trialDrug DevelopmentLubenow et al. · Blood, 2004

Abstract

This analysis of 3 prospective multicenter trials in patients with laboratory-confirmed acute heparin-induced thrombocytopenia (HIT) without clinically evident thromboembolic complications (TECs), isolated HIT, assessed the combined individual end points of death, new TECs, and limb amputation. Patients with the same inclusion criteria who did not receive lepirudin or danaparoid served as a contemporaneous control group. Ninety-one patients were treated with lepirudin (intravenous infusion 0.10 mg/kg/h, no bolus, activated partial thromboplastin time [aPTT]-adjusted to 1.5-2.5 times baseline) for a median of 11.0 days (range, 1-68 days). During the observation period (median 24 days), 13 (14.3%) deaths, 4 (4.4%) new TECs, 3 (3.3%) limb amputations (combined 18 [19.8%]), and 13 (14.3%) major bleeding events occurred. In comparison to the control group (N = 47), the combined end point (P = .0281) and new TECs (P = .02) were reduced, and major bleeding was not significantly different between groups (P = .5419). In renal impairment, lepirudin did not reach its steady state within 4 hours, and additional monitoring every 4 hours after start of lepirudin until steady state is reached is recommended. Lepirudin seems to be effective in patients with isolated HIT. Dose reductions in renal impairment are important. Keeping the aPTT in the range corresponding to 600 to 700 microg/L lepirudin during treatment may minimize bleeding complications.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeClinical TrialJournal ArticleMulticenter StudyResearch Support, Non-U.S. Gov't
Indexed MeSH termsAcute DiseaseAdultAgedAged, 80 and overAnticoagulantsAntithrombin IIIFemaleHeparinHirudinsHumansMaleMiddle Aged

Summary

Lepirudin for prophylaxis of thrombosis in patients with acute isolated heparin-induced thrombocytopenia: an analysis of 3 prospective studies.

Why This Matters for Hirudotherapy

This analysis of three prospective multicenter trials assessed lepirudin (recombinant hirudin) for prophylaxis of thrombosis in 91 patients with acute isolated HIT (without clinically evident thromboembolic complications), compared with 47 contemporaneous controls. Lepirudin significantly reduced the combined endpoint of death, new thromboembolic complications, and limb amputation (P=.0281) and new TECs specifically (P=.02), with no significant difference in major bleeding events (P=.5419); the authors recommended dose adjustments in renal impairment and maintaining plasma levels of 600–700 µg/L to minimize bleeding. This study directly supports the therapeutic value of a leech-derived anticoagulant in preventing thrombosis, highly relevant to ASH's domain. However, it concerns pharmaceutical recombinant hirudin rather than live leech therapy, and the comparison used a contemporaneous rather than randomized control group.

Citation

Lepirudin for prophylaxis of thrombosis in patients with acute isolated heparin-induced thrombocytopenia: an analysis of 3 prospective studies.

Lubenow et al. · Blood, 2004

DOI

Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026

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