Lepirudin (recombinant hirudin) for parenteral anticoagulation in patients with heparin-induced thrombocytopenia. Heparin-Associated Thrombocytopenia Study (HAT) investigators.
Research article published in Circulation (1999)
Abstract
BACKGROUND: We prospectively investigated lepirudin for further parenteral anticoagulation in patients with heparin-induced thrombocytopenia (HIT). METHODS AND RESULTS: Patients with confirmed HIT (n=112) received lepirudin according to need for 2 to 10 days (longer if necessary): A1, treatment: 0.4 mg/kg IV bolus, followed by 0.15 mg. kg(-1). h(-1) intravenous infusion, n=65; A2, treatment in conjunction with thrombolysis: 0.2 mg/kg, followed by 0.10 mg. kg(-1). h(-1), n=4; and B, prophylaxis: 0.10 mg. kg(-1). h(-1), n=43. Outcomes from 95 eligible lepirudin-treated patients were compared with those of historical control patients (n=120). Complete laboratory response (activated partial thromboplastin time ratio >1.5 with </=2 dose increases and platelet count normalization by day 10) was achieved in 65 lepirudin-treated patients (69.1%; 95% CI, 59. 3% to 78.3%). At 2 weeks after cessation of lepirudin, 11 patients died (9.8%), 10 underwent limb amputation (8.9%), and 20 suffered a new thromboembolic complication (17.9%). The average combined event rate per patient-day decreased from 5.1% in the pretreatment period to 1.5% in the treatment period. Thirty-five days after HIT confirmation, fewer lepirudin-treated patients than historical control patients had experienced >/=1 outcome (cumulative incidence 30.9% versus 52.1%; relative risk [RR] 0.71; P=0.12, log-rank test). Bleeding events were more frequent in the lepirudin group than the historical control group (cumulative incidence at 35 days, 44.6% versus 27.2%; RR 2.57; P=0.0001, log-rank test). No difference was observed in bleeding events requiring transfusion (cumulative incidence at 35 days, 12.9% versus 9.1%; RR 1.66; P=0.23, log-rank test); no intracranial bleeding was observed in the lepirudin group. CONCLUSIONS: Lepirudin effectively prevents death, limb amputations, and new thromboembolic complications and has an acceptable safety profile in HIT patients. Treatment should be initiated as soon as possible if HIT is suspected.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Lepirudin (recombinant hirudin) for parenteral anticoagulation in patients with heparin-induced thrombocytopenia. Heparin-Associated Thrombocytopenia Study (HAT) investigators.
Por qué esto importa para la hirudoterapia
Este ensayo prospectivo evaluó lepirudina (hirudina recombinante) para anticoagulación parenteral en 112 pacientes con trombocitopenia inducida por heparina (TIH) confirmada, en comparación con 120 controles históricos. La lepirudina redujo la tasa combinada de eventos por paciente-día del 5,1% previo al tratamiento al 1,5% durante el tratamiento, con menos criterios de valoración acumulativos a 35 días frente a los controles (30,9% vs. 52,1%), aunque los eventos hemorrágicos fueron más frecuentes en el grupo de lepirudina (44,6% vs. 27,2%) sin una diferencia significativa en las hemorragias que requirieron transfusión y sin hemorragia intracraneal. Este estudio demuestra el valor clínico de un anticoagulante derivado de la sanguijuela en una condición potencialmente mortal, directamente relevante para el interés de ASH en las aplicaciones terapéuticas del secretoma de la sanguijuela. Sin embargo, el estudio empleó controles históricos en lugar de concurrentes y evaluó hirudina recombinante de grado farmacéutico, no terapia con sanguijuelas vivas.
Citación
Lepirudin (recombinant hirudin) for parenteral anticoagulation in patients with heparin-induced thrombocytopenia. Heparin-Associated Thrombocytopenia Study (HAT) investigators.
Greinacher et al. · Circulation, 1999
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026