Lepirudin in the management of patients with heparin-induced thrombocytopenia

Sirak PetrosDepartment of Internal Medicine, University of Leipzig, Leipzig, GermanyAbstract: Lepirudin, a recombinant hirudin, is a direct irreversible thrombin inhibitor by binding to both free and clot-bound thrombin. It is approved for treatment of heparin-induced thrombocytopenia (HIT), which i...

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Autor principal:	Sirak Petros
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2008
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/ebaa264c7d5c473a93f13071d9ab3ce4
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spelling	oai:doaj.org-article:ebaa264c7d5c473a93f13071d9ab3ce42021-12-02T07:42:52ZLepirudin in the management of patients with heparin-induced thrombocytopenia1177-54751177-5491https://doaj.org/article/ebaa264c7d5c473a93f13071d9ab3ce42008-09-01T00:00:00Zhttp://www.dovepress.com/lepirudin-in-the-management-of-patients-with-heparin-induced-thrombocy-a2297https://doaj.org/toc/1177-5475https://doaj.org/toc/1177-5491Sirak PetrosDepartment of Internal Medicine, University of Leipzig, Leipzig, GermanyAbstract: Lepirudin, a recombinant hirudin, is a direct irreversible thrombin inhibitor by binding to both free and clot-bound thrombin. It is approved for treatment of heparin-induced thrombocytopenia (HIT), which is a serious antibody-mediated drug reaction mostly associated with the use of unfractionated heparin. Clinical experience during the last 10 years has proved the efficacy of lepirudin in the management of HIT. The major route of elimination of lepirudin is the kidney, accounting for approximately 90% of its systemic clearance. The most important adverse reactions are bleeding and the induction of immunologic reactions. The risk of bleeding can be reduced by implementing an optimal monitoring and dose adjustment strategy, particularly in patients undergoing cardiopulmonary bypass surgery and in those with impaired renal function. Development of antihirudin antibodies may enhance the anticoagulant effect of lepirudin. Anaphylactic reactions associated with lepirudin therapy are rare. The lack of an antidote against lepirudin is still a concern, particularly during cardiopulmonary bypass surgery with a heart-lung machine and during artificial renal support. Currently, hemofiltration using high-flux filter systems is the only available and valid means to manage hirudin overdose. Nevertheless, the drug can be safely used if meticulous monitoring strategy is installed.Keywords: lepirudin, hirudin, heparin-induced thrombocytopenia, direct thrombin inhibitors, bleeding Sirak PetrosDove Medical PressarticleMedicine (General)R5-920ENBiologics: Targets & Therapy, Vol 2008, Iss Issue 3, Pp 481-490 (2008)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Sirak Petros Lepirudin in the management of patients with heparin-induced thrombocytopenia
description	Sirak PetrosDepartment of Internal Medicine, University of Leipzig, Leipzig, GermanyAbstract: Lepirudin, a recombinant hirudin, is a direct irreversible thrombin inhibitor by binding to both free and clot-bound thrombin. It is approved for treatment of heparin-induced thrombocytopenia (HIT), which is a serious antibody-mediated drug reaction mostly associated with the use of unfractionated heparin. Clinical experience during the last 10 years has proved the efficacy of lepirudin in the management of HIT. The major route of elimination of lepirudin is the kidney, accounting for approximately 90% of its systemic clearance. The most important adverse reactions are bleeding and the induction of immunologic reactions. The risk of bleeding can be reduced by implementing an optimal monitoring and dose adjustment strategy, particularly in patients undergoing cardiopulmonary bypass surgery and in those with impaired renal function. Development of antihirudin antibodies may enhance the anticoagulant effect of lepirudin. Anaphylactic reactions associated with lepirudin therapy are rare. The lack of an antidote against lepirudin is still a concern, particularly during cardiopulmonary bypass surgery with a heart-lung machine and during artificial renal support. Currently, hemofiltration using high-flux filter systems is the only available and valid means to manage hirudin overdose. Nevertheless, the drug can be safely used if meticulous monitoring strategy is installed.Keywords: lepirudin, hirudin, heparin-induced thrombocytopenia, direct thrombin inhibitors, bleeding
format	article
author	Sirak Petros
author_facet	Sirak Petros
author_sort	Sirak Petros
title	Lepirudin in the management of patients with heparin-induced thrombocytopenia
title_short	Lepirudin in the management of patients with heparin-induced thrombocytopenia
title_full	Lepirudin in the management of patients with heparin-induced thrombocytopenia
title_fullStr	Lepirudin in the management of patients with heparin-induced thrombocytopenia
title_full_unstemmed	Lepirudin in the management of patients with heparin-induced thrombocytopenia
title_sort	lepirudin in the management of patients with heparin-induced thrombocytopenia
publisher	Dove Medical Press
publishDate	2008
url	https://doaj.org/article/ebaa264c7d5c473a93f13071d9ab3ce4
work_keys_str_mv	AT sirakpetros lepirudininthemanagementofpatientswithheparininducedthrombocytopenia
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Lepirudin in the management of patients with heparin-induced thrombocytopenia

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