Hirudin In Renal Insufficiency

Fischer, Karl-Georg

doi:10.1055/s-2002-35288

Cited by 69 publications

(54 citation statements)

References 35 publications

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“…In our view, the methodologic aspects discussed should lead to cautious interpretation of those data. For a more detailed discussion of sieving properties of hemodialyzer membranes, the reader is referred to recent review articles, which give an in-depth evaluation of the respective literature (7,15).…”

Section: Discussionmentioning

confidence: 99%

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Hemofiltration of Recombinant Hirudin by Different Hemodialyzer Membranes

Benz

Nauck

Böhler

et al. 2007

Clinical Journal of the American Society of Nephrology

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Recombinant hirudin (lepirudin) is a potent direct thrombin inhibitor that is used particularly for treatment of immunemediated heparin-induced thrombocytopenia. Because hirudin is almost exclusively eliminated by the kidneys, its half-life is markedly prolonged in patients with severe renal insufficiency. Therefore, these patients are at risk for bleeding, particularly because no antidote is available. To use hirudin safely in patients who are on renal replacement therapy, knowledge of hirudin-sieving characteristics of different hemodialyzers is required. Data on this issue are sparse and in part contradictory. Eight different conventional low-flux and high-flux hemodialyzers were tested in an in vitro circuit with ultrafiltrate reinfusion. In each experiment, lepirudin concentration was repetitively measured during 3 h in the prefilter, the postfilter, and the filtration line using a chromogenic assay. On the basis of these data, sieving coefficients were calculated. All high-flux hemodialyzers tested allowed filtration of hirudin yet with marked differences in steady-state sieving (sieving coefficients in whole blood: polysulfone

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Section: Discussionmentioning

confidence: 99%

“…Given these data, adequate hirudin anticoagulation in patients with severe renal insufficiency obviously is a demanding task (7). The issue is even more complex when extracorporeal blood purification procedures are required.…”

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confidence: 99%

Hemofiltration of Recombinant Hirudin by Different Hemodialyzer Membranes

Benz

Nauck

Böhler

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…Hemodialysis or hemofiltration can sometimes reduce levels of lepirudin or bivalirudin; however, drug filtration characteristics vary considerably by filter type. 96 Dialytic clearance of argatroban by high-flux membranes is clinically insignificant. 97 Limited data exist on the use of recombinant factor VIIa as a nonspecific antidote for treating severe bleeding in patients with HIT.…”

Section: Fondaparinuxmentioning

confidence: 99%

When Heparins Promote Thrombosis

2005

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“…Owing to its hepatic metabolism and minimal renal clearance, argatroban is theoretically an alternative anticoagulant of choice in patients with renal dysfunction, including renal failure [12,13,14,15]. With the aim of addressing 3 specific questions regarding argatroban use in patients with renal dysfunction, we conducted a critical analysis of available (effective June 2, 2007) literature.…”

Section: Introductionmentioning

confidence: 99%

Argatroban Anticoagulation in Renal Dysfunction: A Literature Analysis

Hursting

Murray

2008

Nephron Clin Pract

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Background/Aims: Argatroban, a hepatically metabolized direct thrombin inhibitor, is approved for use in heparin-induced thrombocytopenia (HIT; several countries) and in antithrombin-deficient patients undergoing hemodialysis (Japan). This literature analysis aimed to determine the effects of renal function on argatroban pharmacokinetics, pharmacodynamics, and its therapeutic dose in HIT and to evaluate argatroban dosing and safety during renal replacement therapy (RRT) and in adults with renal dysfunction undergoing surgical or invasive procedures. Methods: A literature search identified 34 publications (12 prospective studies, 4 retrospective studies, 18 anecdotal reports) that together described 644 argatroban-treated patients (446 with HIT, 82 with antithrombin deficiency) with varying degrees of renal function. Pertinent data were extracted and summarized. Results: In pharmacokinetic studies (40 patients, overall), renal dysfunction exerted little or no clinically significant effects on argatroban pharmacokinetic parameters. For argatroban therapy in HIT, evidence existed that an initial 2 µg/kg/min dose was sometimes excessive; patients with hepatic dysfunction, irrespective of renal function, required reduced initial doses; lesser doses were required in combined hepatic and renal dysfunction than hepatic dysfunction, and for each 30 ml/min decrease in patient creatinine clearance, the therapeutic dose decreased ∼0.1–0.6 µg/kg/min. Argatroban was well tolerated and enabled RRT with little or no thrombotic or hemorrhagic complications. Experiences with argatroban in renally impaired patients undergoing procedures besides RRT were limited. Conclusion: Current literature suggests that argatroban is well tolerated and provides adequate anticoagulation in patients with renal dysfunction or failure, including individuals with HIT or antithrombin deficiency where anticoagulant options are limited.

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Hirudin In Renal Insufficiency

Cited by 69 publications

References 35 publications

Hemofiltration of Recombinant Hirudin by Different Hemodialyzer Membranes

Hemofiltration of Recombinant Hirudin by Different Hemodialyzer Membranes

When Heparins Promote Thrombosis

Argatroban Anticoagulation in Renal Dysfunction: A Literature Analysis

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