A direct thrombin inhibitor utilized in heparin-induced thrombocytopenia.
A hirudin recombinant analogue to prevent further thromboembolic disease in HIT.
Does not cross-react with heparin, has a short half-life, and can inactivate clot-bound thrombin, can be given intravenously or subcutaneously and can be monitored by aPTT or clotting time analysis.
Initial bolus 0.4 mg/kg intravenously, 0.15 mg/kg/h by infusion.
Renal dosing creatinine clearance 45-60-0.2 mg/kg bolus, then .075 mg/kg/h, creatinine clearance 30-44-0.2 mg/kg bolus, then 0.045 mg/kg/h, 15-29-.2 mg/kg bolus, then .0225 mg/kg/h, creatinine clearance <15 avoid this drug.
For HIT initial Lepirudin infusion rate should be no higher than 0.10 mg/kg/h for patients with normal kidney function, with lower infusion rates for those with impaired renal function.
It is recommended that APTT monitoring be performed at 4 hour intervals until it is apparent that steady state within the normal range is achieved.
Usage in patients with renal insufficiency with creatinine clearance >30 cc/min but greater than 60 cc/min should be monitored using the activated partial thromboplastin time, and the dose reduced.
In patients with creatinine clearance less than 30 cc/min it is recommended not to use this agent.
40-47% of patients develop antihirudin antibodies in patients exposed to treatment.
Development of antihirudin antibodies related to duration of lepirudin exposure and these antibodies reduce lepirudin clearance and increase anticoagulant effect by prolonging activated partial thromboplastin time, in approximately 3% of patients.
After reexposure asymptomatic hypotension may occur.
Reexposure rarely associated with anaphylaxis.