Anticoagulation with r-hirudin in regular haemodialysis with heparin-induced thrombocytopenia (HIT II)
First long-term application case series published in Wiener Klinische Wochenschrift (1997)
Abstract
A 69-year-old female patient with renal failure developed heparin-induced thrombocytopenia type II (HIT II) two months after starting haemodialysis therapy with heparin as anticoagulant and a 6-week course of thromboembolism prophylaxis with enoxaparin sodium. The platelet count dropped by 50% as compared with initial values and ex vivo platelet aggregation induced by heparin antibodies (HIPA-test) was detected. Haemodialysis therapy was complicated by a massive thrombosis of dialyzer and ensuing repeated interruptions of treatment. After confirmation of the diagnosis of HIT II haemodialysis therapy was continued with hirudin as anticoagulant. Polysulfone dialyzers and an intravenous bolus of 0.14 mg/kg of recombinant hirudin (r-hirudin) achieved efficient haemodialysis therapy of 4.5 hours, with a minimum therapeutic blood level of hirudin of 0.5 micrograms/mL. More than 50 regular haemodialysis with hirudin anticoagulation were performed without additional problems. The ecarin clotting time (ECT) was used as bedside method to monitor blood levels and for dosage adjustments of hirudin. After the 34th haemodialysis, the frequency (previously 3-4 haemodialyses sessions/week) was reduced to 2 sessions/week. The creatinine clearance increased continuously from initially 2.6 to 10.4 ml/min after the 13th week of hirudin-anticoagulated haemodialysis and the platelet count normalized. In conclusion, we report the first long-term administration of r-hirudin to a patient on regular haemodialysis therapy complicated by heparin-induced thrombocytopenia. The use of hirudin as anticoagulant along with dialyzers impermeable to hirudin offers a novel alternative means of anticoagulation and, even in patients with HIT, enables performing an efficient haemodialysis therapy. Hirudin dosage must be individually adjusted by using bedside drug monitoring of plasma concentrations.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
First long-term application of recombinant hirudin (lepirudin) in regular hemodialysis patients with heparin-induced thrombocytopenia (HIT II) — landmark clinical translation.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe a una paciente de 69 años en hemodiálisis que desarrolló trombocitopenia inducida por heparina tipo II (HIT II) y fue exitosamente transicionada a anticoagulación con hirudina recombinante (r-hirudina) utilizando dializadores de polisulfona y un bolo intravenoso de 0,14 mg/kg, con más de 50 sesiones regulares de hemodiálisis realizadas sin problemas adicionales y con normalización del recuento plaquetario. Se utilizó el tiempo de coagulación con ecarina para la monitorización a la cabecera del paciente y el ajuste de la dosis. Para ASH, este reporte es relevante porque documenta una aplicación clínica sostenida de hirudina — el anticoagulante característico del secretoma de la sanguijuela medicinal — en un escenario de anticoagulación del mundo real donde la heparina estaba contraindicada. El estudio es un reporte de un solo caso sin grupo comparativo ni protocolo de dosificación controlado, y se refiere a la hirudina recombinante más que a la terapia con sanguijuelas vivas o al extracto salival crudo; la eficacia clínica más amplia no puede inferirse a partir de una sola paciente.
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026