Desirudin: a review of its use in the management of thrombotic disorders
Review published in Drugs (2000)
Abstract
UNLABELLED: Desirudin, a recombinant hirudin used in the prevention and management of thromboembolic disease, is a thrombin inhibitor which binds directly and with high affinity to clot-bound and fluid phase thrombin. As a prophylaxis in patients undergoing hip replacement surgery, desirudin was significantly more effective in reducing the incidence of deep vein thrombosis (DVT) than either unfractionated or low molecular weight heparin. However, results in patients with acute coronary syndromes are less conclusive. A significant reduction with desirudin compared with heparin in the incidence of death or non-fatal (re)infarction at 24 hours in patients with acute myocardial infarction (MI) was reported in the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) IIb trial but not in the TIMI (Thrombolysis and Thrombin Inhibition in Myocardial Infarction) 9B trial. Despite the early reduction shown in GUSTO IIb, desirudin was not associated with an improved long term clinical benefit at 30 days compared with heparin. Similar results were seen in patients with unstable angina/non-Q-wave MI enrolled in the GUSTO IIb trial. In addition, desirudin and heparin showed similar efficacy in preventing restenosis 30 weeks after coronary angioplasty for unstable angina, despite desirudin being associated with a significant reduction in the rate of cardiac events within the first 96 hours. Desirudin is as well tolerated as heparin with a similar incidence of moderate and severe bleeding, intracranial haemorrhage or stroke reported when trialled in the prevention of DVT associated with hip replacement surgery or the treatment of acute coronary syndromes. However, in the GUSTO IIb trial a significantly higher incidence of transfusions was observed in patients with unstable angina/non-Q-wave MI. CONCLUSIONS: Desirudin is clearly more effective than heparin in the prevention of DVT in patients undergoing elective hip replacement, although cost factors may influence its ultimate place in therapy. In the treatment of acute coronary syndromes the role of desirudin is less certain; however, it may be useful for patients in whom heparin therapy is not a viable option.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Резюме
Desirudin: a review of its use in the management of thrombotic disorders.
Почему это важно для гирудотерапии
В данной статье оценивается клиническое применение десирудина, охарактеризованного в реферате как рекомбинантный гирудин и ингибитор тромбина, при лечении тромбоэмболических заболеваний, включая профилактику тромбоза глубоких вен и острые коронарные синдромы. В реферате сообщается, что десирудин достоверно превосходил нефракционированный и низкомолекулярный гепарин по эффективности снижения частоты ТГВ после эндопротезирования тазобедренного сустава, тогда как результаты при острых коронарных синдромах были менее убедительными и не показали стойкого долгосрочного клинического эффекта через 30 суток. Переносимость десирудина в целом была сопоставима с таковой гепарина, хотя в одном исследовании наблюдалась более высокая частота трансфузий. В реферате не упоминаются пиявки, слюна пиявок или гирудотерапия, поэтому связь с предметной областью ASH ограничивается фармацевтическим термином «рекомбинантный гирудин» без дальнейшего пояснения.
Цитирование
Desirudin: a review of its use in the management of thrombotic disorders
Matheson AJ et al. · Drugs, 2000
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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