Treatment of heparin-induced thrombocytopenia: is there a role for bivalirudin?

Review published in Pharmacotherapy (2006)

Última actualización: June 18, 2026Revisado por: ASH Editorial Board

Artículo de investigación — revisión de evidenciaReferencia del artículo

Evidence: Narrative reviewEnsayos clínicosDesarrollo de fármacosSeybert et al. · Pharmacotherapy, 2006

Abstract

The recognition and management of heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis syndrome (HITTS) has been evolving over the past several years. Although HIT is a relatively uncommon adverse event in patients receiving heparin therapy, it bears a significant risk of thrombotic events. If patients are left untreated, 50% can develop thrombosis. Several direct thrombin inhibitors have been studied as alternative anticoagulants in patients with HIT. Lepirudin and argatroban are both approved by the United States Food and Drug Administration (FDA) for the management of HIT. Lepirudin requires dosage adjustments in patients with renal insufficiency and has potential for antibody formation. Argatroban requires dosage adjustments in patients with hepatic insufficiency. Argatroban increases the international normalized ratio when coadministered with warfarin, leading to dosage difficulties when transitioning to warfarin therapy. Bivalirudin is the most recent direct thrombin inhibitor to be introduced to the market, but it is not currently FDA approved for HIT. Controversy still exists over which direct thrombin inhibitor to use, especially in acutely ill patients and in those requiring invasive or surgical procedures. Bivalirudin has a relatively short half-life and a predictable response, which makes it attractive as an anticoagulant in patients requiring invasive or surgical procedures, those who are acutely ill, or patients with both renal and hepatic insufficiency. It offers promise as an additional direct thrombin inhibitor for use in patients with HIT, but additional studies need to be performed to further define its use.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview

Indexed MeSH termsAnticoagulantsClinical Trials as TopicHeparinHirudinsHumansPeptide FragmentsPostoperative ComplicationsRecombinant ProteinsThrombinThrombocytopenia

Resumen

Por qué esto importa para la hirudoterapia

Esta revisión examina los inhibidores directos de la trombina para la trombocitopenia inducida por heparina, discutiendo lepirudina, argatrobán y bivalirudina — esta última descrita como un agente más nuevo y prometedor con vida media corta y respuesta predecible, aunque aún no aprobado por la FDA para HIT. Tanto la lepirudina (hirudina recombinante) como la bivalirudina (un péptido sintético basado en hirudina, aunque el resumen no establece explícitamente su derivación de la hirudina) están conectadas con el secretoma de la sanguijuela a través de su linaje molecular procedente de la hirudina. La relevancia con el dominio de ASH es clara en tanto que el artículo revisa la experiencia clínica con agentes derivados de o modelados sobre el anticoagulante de la sanguijuela. La salvedad es que se trata de una revisión narrativa sin nuevos datos primarios, la conexión de la bivalirudina con la hirudina no se establece en el resumen, y el foco es el manejo farmacéutico más que la hirudoterapia en sí.