Anticoagulation for patients with heparin-induced thrombocytopenia using recombinant hirudin during cardiopulmonary bypass

Liu, Hong; Fleming, Neal; Moore, P. G.

doi:10.1016/s0952-8180(02)00386-0

Cited by 18 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…54 Lepirudin has been used during CPB in more than 70 patients in published reports. 2,[55][56][57] When administered at the levels required for CPB, lepirudin anticoagulation is monitored using the ecarin clotting time (ECT) test (a snake venom prothrombin activatorbased assay). The ECT test allows for sensitive monitoring of high lepirudin concentrations during CPB because a linear relationship is seen between therapeutic concentrations of lepirudin required for CPB and the prolongation of ECT values.…”

Section: Lepirudinmentioning

confidence: 99%

The Use of Direct Thrombin Inhibitors in Cardiovascular Surgery in Patients with Heparin-Induced Thrombocytopenia

Greinacher

2004

Semin Thromb Hemost

View full text Add to dashboard Cite

One of the most important adverse drug reactions that physicians encounter is the life- and limb-threatening prothrombotic syndrome known as heparin-induced thrombocytopenia (HIT). Unfractionated heparin (UFH), administered during cardiopulmonary bypass (CPB), is highly immunogenic. Heparin-dependent antibodies can develop in 25 to 50% of UFH-treated cardiac surgery patients within 5 to 10 days. These antibodies can activate platelets and are considered the causative agents of HIT. HIT is a relatively common complication, occurring in 1 to 3% of cardiovascular surgery patients when UFH administration is continued postoperatively. It is strongly associated with new thromboembolic events leading to limb amputation and death. In acute or recent (< 100 days) HIT, alternative anticoagulatory regimens are needed during CPB surgery for prevention of HIT-related thrombosis. Treatment options for such patients now generally include the use of alternative anticoagulants such as lepirudin, bivalirudin, or danaparoid, as well as a combined treatment with platelet-function inhibitors and heparin. In patients with a history of HIT and no detectable antibodies, heparin is currently the safest approach for high-dose anticoagulation during CPB. Before and after surgery, however, alternative anticoagulants should be used. The risk of clinical HIT after heart surgery could potentially be reduced by using low-molecular-weight heparins for postsurgery anticoagulation.

show abstract

Section: Lepirudinmentioning

confidence: 99%

The Use of Direct Thrombin Inhibitors in Cardiovascular Surgery in Patients with Heparin-Induced Thrombocytopenia

Greinacher

2004

Semin Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…Among them, medicinal animals are a major source of thrombolytic agents, such as lumbrokinase and earthworm fibrinolytic enzyme II from earthworms [8,33], Agacutase from D. acutus snake venoms [10,11], hirudins from leech Hirudinaria manillensis [6], fibrinolytic protease UFEIII from Urechis unicinctus [4], and several of these compounds, such as hirudin [34], lumbrokinase [35], ancrod [36] have been widely applied in the clinic and achieved good results.…”

Section: Discussionmentioning

confidence: 99%

Purification and biochemical characterization of a novel fibrinolytic enzyme, PSLTro01, from a medicinal animal Porcellio scaber Latreille

Tian

Лі

Li-wei

et al. 2015

International Journal of Biological Macromolecules

View full text Add to dashboard Cite

“…Over the past decade, a number of case reports have described the successful use of lepirudin in patients with HIT requiring cardiac surgical procedures [25,39,[62][63][64]. Koster et al, in a series of 57 patients with HIT who underwent CPB while receiving lepirudin, [39] dose adjusted according to the Ecarin Clotting Time (ECT) to maintain plasma concentrations of 3.5-4.0 lg/ml, observed that at the conclusion of CPB, elimination of lepirudin was enhanced by using modified zero-balanced ultrafiltration and forced diuresis.…”

Section: Hirudinmentioning

confidence: 99%

Anticoagulant therapy during cardiopulmonary bypass

Yavari

Becker

2008

J Thromb Thrombolysis

View full text Add to dashboard Cite

The prothrombotic and hemostatic-altering environment that characterizes cardiac surgery in general and cardiopulmonary bypass (CPB) in particular is unparalleled in medicine, causing, in an alarming number of patients, both thrombotic and hemorrhagic events. Fundamentally, the primary objective of anticoagulant therapy during CPB is to prevent thrombin generation and its attendant prothrombotic, proinflammatory, and vascular effects. Though anticoagulation with unfractionated heparin has been the standard of care for more than a half-century for patients undergoing cardiac surgery, inherent limitations, and an unfavorable safety profile will increasingly stimulate the investigation and development of more safe and effective therapies.

show abstract

Anticoagulation for patients with heparin-induced thrombocytopenia using recombinant hirudin during cardiopulmonary bypass

Cited by 18 publications

References 20 publications

The Use of Direct Thrombin Inhibitors in Cardiovascular Surgery in Patients with Heparin-Induced Thrombocytopenia

The Use of Direct Thrombin Inhibitors in Cardiovascular Surgery in Patients with Heparin-Induced Thrombocytopenia

Purification and biochemical characterization of a novel fibrinolytic enzyme, PSLTro01, from a medicinal animal Porcellio scaber Latreille

Anticoagulant therapy during cardiopulmonary bypass

Contact Info

Product

Resources

About