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.
Резюме
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.
Почему это важно для гирудотерапии
Данная обзорная статья рассматривает рекомбинантный гирудин (лепирудин) в качестве альтернативного антикоагулянта при гепарин-индуцированной тромбоцитопении (HIT), охватывая рекомендации по дозированию, вариабельность периода полувыведения, зависящего от функции почек (1–200 часов), примерно 15% риск тяжёлого кровотечения, антигирудиновые антитела, мониторинг посредством экаринового времени свёртывания, а также сравнение с данапароидом и аргатробаном. Для сферы деятельности ASH релевантность минимальна и косвенна: в аннотации обсуждается только рекомбинантный фармацевтический продукт и не содержится упоминаний пиявок, слюны пиявок, гирудотерапии или слюнного секретома. Это обзор по фармакотерапии, сфокусированный на клиническом ведении антикоагулянтной лекарственной терапии при специфическом тромботическом расстройстве, не имеющий прямой связи с гирудотерапией или лечебной практикой на основе пиявок, согласно аннотации.
Цитирование
Hirudin in heparin-induced thrombocytopenia.
Lubenow N, Greinacher A · Seminars in thrombosis and hemostasis, 2002
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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