Hirudin in heparin-induced thrombocytopenia
Research article published in Seminars in thrombosis and hemostasis (2002)
Abstract
Heparin-induced thrombocytopenia (HIT), a serious side effect of heparin treatment, requires alternative anticoagulation in most affected patients. The recombinant hirudin (r-hirudin) lepirudin has been approved for this purpose after two prospective trials in laboratory-confirmed HIT patients. Other drugs available for this purpose are danaparoid sodium (a heparinoid) and argatroban, a synthetic direct thrombin inhibitor. In this article, recommendations for optimal use of r-hirudin in HIT are given, covering therapy in uncomplicated patients as well as in special situations such as heparin reexposure of HIT patients. Because lepirudin's half-life depends on renal function, it may vary between 1 and 200 hours, which requires individual dose adjustments. Lepirudin compares favorably with danaparoid, based on retrospective data. No direct comparisons of lepirudin with argatroban are available, but argatroban might offer advantages in patients with renal failure, because it is mainly eliminated hepatically. Major hemorrhage, the main risk of lepirudin treatment, occurring in about 15% of patients, makes close monitoring important. New monitoring tools, such as the ecarin clotting time (ECT), might further reduce bleeding risks. Antihirudin antibodies, which can alter the pharmacokinetics as well as the pharmacodynamics of hirudin, can also be countered by close monitoring and appropriate dose adjustments. Whereas hirudins have not yet managed to gain importance in non-HIT indications such as unstable coronary syndromes, they have a major role to play in the treatment of HIT. The choice between the available drugs for HIT, namely lepirudin, danaparoid, and argatroban, has to be made according to the clinical presentation of the patient.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Heparin-induced thrombocytopenia (HIT), a serious side effect of heparin treatment, requires alternative anticoagulation in most affected patients. The recombinant hirudin (r-hirudin) lepirudin has been approved for this purpose after two prospective trials in laboratory-confirmed HIT patients.
Por qué esto importa para la hirudoterapia
Este artículo de revisión examina el hirudin recombinante (lepirudin) como anticoagulante alternativo para la trombocitopenia inducida por heparina (HIT), abordando las recomendaciones de dosificación, la variabilidad de la semivida dependiente de la función renal (1–200 horas), el riesgo de hemorragia mayor de aproximadamente el 15%, los anticuerpos antihirudin, la monitorización mediante el tiempo de coagulación con ecarina, y las comparaciones con danaparoid y argatroban. Para el ámbito de la ASH, la relevancia es mínima e indirecta: el resumen solo analiza el producto farmacéutico recombinante y no contiene mención de sanguijuelas, saliva de sanguijuela, terapia con sanguijuelas ni el secretoma salival. Se trata de una revisión de farmacoterapia centrada en el manejo clínico de fármacos anticoagulantes en un trastorno trombótico específico, sin conexión directa con la hirudoterapia ni con la práctica terapéutica basada en sanguijuelas descrita en el resumen.
Citación
Hirudin in heparin-induced thrombocytopenia.
Lubenow N, Greinacher A · Seminars in thrombosis and hemostasis, 2002
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Añadido a la biblioteca ASH: March 18, 2026 · Última actualización del sitio: June 18, 2026