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)
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.
Resumen
Lepirudin for prophylaxis of thrombosis in patients with acute isolated heparin-induced thrombocytopenia: an analysis of 3 prospective studies.
Por qué esto importa para la hirudoterapia
Este análisis de tres ensayos prospectivos multicéntricos evaluó la lepirudina (hirudina recombinante) para la profilaxis de trombosis en 91 pacientes con HIT aislada aguda (sin complicaciones tromboembólicas clínicamente evidentes), en comparación con 47 controles contemporáneos. La lepirudina redujo significativamente la variable combinada de muerte, nuevas complicaciones tromboembólicas y amputación de extremidades (P=0,0281) y los nuevos TEC específicamente (P=0,02), sin diferencia significativa en eventos de hemorragia mayor (P=0,5419); los autores recomendaron ajustes de dosis en insuficiencia renal y mantener niveles plasmáticos de 600–700 µg/L para minimizar la hemorragia. Este estudio respalda directamente el valor terapéutico de un anticoagulante derivado de la sanguijuela en la prevención de trombosis, altamente relevante para el ámbito de ASH. Sin embargo, se refiere a la hirudina recombinante farmacéutica en lugar de a la terapia con sanguijuelas vivas, y la comparación utilizó un grupo control contemporáneo en lugar de aleatorizado.
Citación
Lepirudin for prophylaxis of thrombosis in patients with acute isolated heparin-induced thrombocytopenia: an analysis of 3 prospective studies.
Lubenow et al. · Blood, 2004
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026