Hirudin in renal insufficiency
Research article published in Seminars in thrombosis and hemostasis (2002)
Abstract
Recombinant hirudins (r-hirudins) are potent direct thrombin inhibitors increasingly used for alternative anticoagulation, especially in heparin-induced thrombocytopenia. R-hirudins are almost exclusively eliminated by the kidneys, and a close correlation between r-hirudin clearance and endogenous creatinine clearance has been observed. Accordingly, the pharmacokinetics of r-hirudin are altered in patients with renal insufficiency. A decline of renal r-hirudin clearance is associated with an increase of r-hirudin half-life and the area under the curve (AUC). Therefore, renal impairment necessitates reduction of r-hirudin dose to avoid overdose or inadequate accumulation of the thrombin inhibitor. To this end, close monitoring of r-hirudin anticoagulation is required, which at best is performed by measuring r-hirudin blood levels by ecarin clotting times (ECT) or chromogenic assays, in addition to activated partial thromboplastin time (aPTT). Recent studies showed that r-hirudin anticoagulation is feasible in acute or chronic renal failure treated with continuous or intermittent renal replacement therapy, if appropriate r-hirudin dosing and adequate monitoring are warranted. High-volume hemofiltration with r-hirudin-permeable hemodialyzers constitutes a valuable means to markedly reduce r-hirudin blood concentration and total r-hirudin body content in case of r-hirudin overdose or r-hirudin-associated bleeding. In the future, the hepatically eliminated direct thrombin inhibitor argatroban may facilitate alternative anticoagulation in patients with renal insufficiency.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Recombinant hirudins (r-hirudins) are potent direct thrombin inhibitors increasingly used for alternative anticoagulation, especially in heparin-induced thrombocytopenia.
Por qué esto importa para la hirudoterapia
Esta revisión examina la farmacocinética, la dosificación y la monitorización clínica de las hirudinas recombinantes (r-hirudinas)—inhibidores directos potentes de la trombina—en pacientes con insuficiencia renal, documentando cómo la depuración renal reducida prolonga la semivida y aumenta el área bajo la curva, lo que requiere reducción de dosis y monitorización estrecha. La información farmacológica detallada sobre la eliminación de la hirudina, el riesgo de acumulación, las estrategias de monitorización (tiempo de coagulación con ecarina, ensayos cromogénicos, aPTT) y la eliminación durante la terapia de reemplazo renal es relevante para comprender la anticoagulación basada en hirudina dentro del ámbito de la ASH. Sin embargo, el artículo aborda hirudinas recombinantes farmacéuticas para la anticoagulación clínica sistémica en afecciones como la trombocitopenia inducida por heparina; no involucra sanguijuelas, terapia con sanguijuelas ni materiales derivados de sanguijuelas, y el resumen no proporciona datos cuantitativos originales de resultados.
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Añadido a la biblioteca ASH: March 18, 2026 · Última actualización del sitio: June 18, 2026