Generation of Anti-Hirudin Antibodies in Heparin-Induced Thrombocytopenic Patients Treated With R-Hirudin

Abstract

R-hirudin may be antigenic in patients with heparin-induced thrombocytopenia. More comprehensive investigations will be required to determine the biological relevance of this and to establish the antibody-generation pattern in other diseases.

Treatment and Prevention of Heparin-Induced Thrombocytopenia

“…154,155 Lepirudin and Fondaparinux: Lepirudin is dependent on renal clearance and antihirudin antibodies may develop that further reduce renal clearance. 156,157 Because of the prolonged half-life of this agent in renal failure, intermittent doses of lepirudin prior to dialysis may continue to exert an anticoagulant effect between dialysis sessions. Small studies evaluating hirudin during continuous venovenous hemofi ltration, predominantly in patients without HIT, have reported an increased risk of hemorrhagic complications.…”

Antihirudin antibodies following low-dose subcutaneous treatment with desirudin for thrombosis prophylaxis after hip-replacement surgery: incidence and clinical relevance

“…Numerically this rate is much lower than the rate observed in patients with HIT receiving lepirudin. [12][13][14] However, using Kaplan-Meier calculation, the risk of immunization per time exposed seems to be identical in both patient populations (Figure 1). Thus the total rate of immunization depends on treatment duration and time point of blood sampling.…”

“…12 In another study with lepirudin given to patients with HIT (up to 26 days), up to 74% of patients developed antihirudin antibodies of the IgG, IgA, and/or IgM class. 13,14 None of these patients developed allergic reactions.…”

“…13,14 During a mean duration of treatment of 14.4 days, 44% of 198 patients treated with lepirudin developed antihirudin antibodies of the immunoglobulin G (IgG) class, which occurred as early as day 4 (peak at days 8-9). Of 87 patients with detectable antihirudin antibodies, 61 (70.1%) developed during treatment, 23 (26.4%) occurred after cessation of lepirudin, and 3 (3.5%) became positive during a second treatment course with lepirudin only.…”

Management of heparin allergy in pregnancy

“…Hence it is a logical choice for use in heparin-allergic patients in pregnancy. Its long-term use, however, has been associated with the generation of antihirudin antibodies [5] and with variable effects on clotting time [6].…”