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.
Resumen
Comparison of bivalirudin to lepirudin and argatroban in patients with heparin-induced thrombocytopenia.
Por qué esto importa para la hirudoterapia
This comparative study evaluated the safety, effectiveness, and dosing of bivalirudin against argatroban and lepirudin (a recombinant hirudin) in patients with suspected heparin-induced thrombocytopenia. The findings indicate that bivalirudin provided a significantly shorter time to therapeutic aPTT and a lower bleeding rate (7%) compared to lepirudin (56%), offering valuable comparative data on the clinical risks of recombinant hirudin. However, the relevance to applied hirudotherapy is limited, as the research evaluates isolated pharmaceutical derivatives rather than live leeches or crude leech secretions. Additionally, it is a single-center analysis with a limited sample of 48 patients, which the authors note requires larger studies for confirmation.
Citación
Comparison of bivalirudin to lepirudin and argatroban in patients with heparin-induced thrombocytopenia
Bain J et al. · American journal of health-system pharmacy, 2015
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026