Lepirudin for prophylaxis of thrombosis in patients with acute isolated heparin-induced thrombocytopenia: an analysis of 3 prospective studies

Treatment and Prevention of Heparin-Induced Thrombocytopenia

“…76,78 DTIs lepirudin and argatroban have each been compared with historical controls who received the best available care at the time. [79][80][81][82][83] ( Tables 8, 9 ). In the majority of cases, best available The anticipated absolute effect is expressed as risk difference (and its 95% CI) and is based on the baseline risk in the comparison group and the relative effect of the intervention (and its 95% CI).…”

“…Whether taking this step alone is enough to prevent the development of thrombotic complications in patients who have isolated HIT has been evaluated in pooled analyses of prospective cohort studies with historical controls 76,78 and in three retrospective case series. 6,42,70 The prospective studies compared DTIs lepirudin and argatroban with historical controls in whom heparin was discontinued with or without the addition of warfarin [79][80][81][82][83] ( Tables 13,14 ). An overview of the methodology of these studies is available in the online data supplement (Table S1).…”

Heparin-Induced Thrombocytopenia

“…4,13 Lepirudin also is effective for patients with isolated HIT when a lower-dose protocol is used (0.10 mg/kg per hour adjusted by aPTT without initial bolus). 14 Because lepirudin is a foreign protein, its use frequently triggers antihirudin antibodies that occasionally lead to drug accumulation, presumably from impaired renal clearance of lepirudin-immunoglobulin G (IgG) complexes. Fatal anaphylaxis after intravenous bolus administration has been reported in patients who received lepirudin within the previous few months.…”

Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score–matched study

“…13 Evidence supporting the use of argatroban and lepirudin come from pooled-analyses of prospective cohort studies. 12,[14][15][16][17][18] Both agents demonstrate a benefit in preventing new thrombosis compared with the use of vitamin-K antagonists. However, danaparoid has been demonstrated to carry an approximate 10% in vitro cross-reactivity rate with HIT-associated antibodies, thus possibly potentiating the thrombotic complications of HIT.…”